Benlysta (belimumab) — United Healthcare

Initial criteria

• Diagnosis of systemic lupus erythematosus
• Patient is currently receiving standard immunosuppressive therapy (e.g., hydroxychloroquine, chloroquine, prednisone, azathioprine, methotrexate)
• Patient does not have severe active central nervous system lupus
• Patient is not receiving Benlysta in combination with any of the following: Targeted Immunomodulator (e.g., Enbrel [etanercept], Humira [adalimumab], Cimzia [certolizumab], Kineret [anakinra]), Lupkynis (voclosporin), Saphnelo (anifrolumab-fnia)

Reauthorization criteria

• Documentation of positive clinical response to Benlysta therapy
• Patient is not receiving Benlysta in combination with any of the following: Targeted Immunomodulator (e.g., Enbrel [etanercept], Humira [adalimumab], Cimzia [certolizumab], Kineret [anakinra]), Lupkynis (voclosporin), Saphnelo (anifrolumab-fnia)

Approval duration

12 months