Benlysta (belimumab) Subcutaneous — Point32Health

Initial criteria

• Documented diagnosis of active lupus nephritis
• Documentation the diagnosis of active lupus nephritis is confirmed by urine/blood tests or kidney biopsy
• Patient age ≥ 5 years
• Prescribing physician is a rheumatologist or nephrologist
• Documentation of ONE of the following: (a) Use in combination with at least one agent from the following standard of care therapeutic categories: Antimalarial (e.g., hydroxychloroquine), corticosteroids (e.g., prednisone), or immunosuppressants (e.g., methotrexate); OR (b) Clinical inappropriateness of use of ALL of the following standard of care therapeutic categories: Antimalarials, corticosteroids, and immunosuppressants
• Documentation Benlysta will not be used in combination with other biologics