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Appeals


If your office has prescribed Rituxan® (rituximab), but your patient's insurer has denied coverage, you can appeal that decision. Rituxan® Access Solutions might be able to help as you resolve the situation. Here is what you can do.

  1. Understand why the request or claim has been denied. This should be in the insurer's letter of denial or the patient's Explanation of Benefits (EOB) letter.
  2. Contact Rituxan Access Solutions to help you put together an appeal.
  3. Complete and submit the required forms and documents to the insurer before the appeal deadline. Rituxan Access Solutions can provide information about this process.

An appeal may also be pursued without Rituxan Access Solutions. Here is what you can do.

  1. Understand why the request or claim has been denied. This should be in the insurer's letter of denial or the patient's EOB letter.
  2. Gather the appeal information for Rituxan. Use the resources on this site to help you gather the documents and information you need for a successful appeal.
  3. Complete and submit the required forms and documents to the insurer before the appeal deadline.   
  4. If the insurer approves the appeal, it will notify your office. Rituxan can then be dispensed  your patient through an authorized distributor. You may also purchase Rituxan, administer it and bill it. If the appeal is denied, contact us for more information. Keep copies of all documents related to the case before referring to us - including the denial letter.

Please note: This description of the appeals process is for informational purposes only. The submission of an appeal is the responsibility of the patient and your office. Rituxan Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item. Each health insurer and patient case may require different information. Please review each denial and the health insurer's guidelines to determine what to include in your patient's appeal package. Your Genentech BioOncology¿ Field Reimbursement Manager has unique health plan-specific knowledge and can help you determine the specific requirements for your patient.

The flow chart seen here illustrates the denials and appeals process.

 

 

 

INDICATIONS

RITUXAN® (Rituximab) is indicated for the treatment of patients with:

  • Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent
  • Previously untreated follicular, CD20-positive, B-cell NHL in combination with CVP chemotherapy
  • Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL, as a single agent, after first-line CVP chemotherapy
  • Previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens
  • Previously untreated CD20-positive CLL in combination with FC chemotherapy
  • Previously treated CD20-positive CLL in combination with FC chemotherapy

People with serious infections should not receive RITUXAN

IMPORTANT SAFETY INFORMATION
RITUXAN can cause serious side effects that can lead to death, including: infusion reactions, tumor lysis syndrome (TLS; kidney failure due to fast breakdown of cancer cells), severe skin and mouth reactions, and progressive multifocal leukoencephalopathy (PML; a rare, serious brain infection).

RITUXAN has also been associated with serious and life-threatening side effects, including: the return of active hepatitis B virus infection with sudden and serious liver problems including liver failure, and death, other serious infections that can lead to death, heart problems, kidney problems, and stomach and serious bowel problems including blockage and tears in the bowel that can sometimes lead to death.

The most common side effects of RITUXAN seen in patients with non-Hodgkin's lymphoma were infusion reactions, fever, chills, low white blood cells, infections, body aches, and tiredness. The most common side effects of RITUXAN in patients with chronic lymphocytic leukemia were infusion reactions and low white blood cells. Before starting treatment with RITUXAN it is important to talk to your doctor about your medical history.

Tell your doctor about any side effect that bothers you or that does not go away. These are not all of the possible side effects with RITUXAN. For more information, ask your doctor.

Please see full Prescribing Information, including the Medication Guide.

Rituxan® and its logo are trademarks of Biogen Idec, Inc.
The Access Solutions logo and the Access Solutions Treatment made possible logo are trademarks of Genentech USA, Inc.

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