Benlysta (belimumab) Subcutaneous — Point32Health

Initial criteria

• Documented diagnosis of active systemic lupus erythematosus
• Documentation that prior to initiating therapy with the requested medication, the patient is auto-antibody positive (e.g., ANA, anti-dsDNA, anti-Sm)
• Patient age ≥ 5 years
• Prescribed by or in consultation with a rheumatologist
• Documentation of ONE of the following: (a) Use in combination with at least one agent from the following standard of care therapeutic categories: Antimalarials (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