Benlysta® (belimumab)

Authorization forms (both SC and IV formulations)

Traditional, Optimized & Medicaid (03/2019) 

Medicare Part B (01/2019)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J0490

Benefit: Medical or Pharmacy

Notes: Treatment of systemic lupus erythematosus