Efgartigimod (Vyvgart)

Covered: Vyvgart (efgartigimod) is covered for adults (≥18) with generalized myasthenia gravis who are anti‑AChR antibody positive and is not authorized for patients who are anti‑AChR negative or who do not meet the specified prior‑therapy and symptom criteria. Key requirements: documented anti‑AChR positivity, age ≥18, prior pyridostigmine unless failed/contraindicated, prior trial of two immunosuppressants ≥1 year (or documented failure/contraindication), evidence of unresolved gMG symptoms, neurologist prescription/consultation, dosing 10 mg/kg IV weekly ×4 (or 1200 mg if ≥120 kg), initial approval 6 months/renewal 12 months with documented clinical benefit, cycles not initiated sooner than 50 days, and complete documentation of labs, prior therapies, dosing/infusions and clinical response.

"Vyvgart is indicated for the treatment of generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive."