Intravenous Immune Globulin

IVIG is covered for FDA‑approved and specified compendial off‑label uses (e.g., primary and secondary humoral immunodeficiencies, CIDP, ITP, MMN, GBS, myasthenia gravis, autoimmune blistering diseases, ABMR/desensitization, CMV/parvovirus infections, post‑exposure measles/varicella/tetanus prophylaxis, etc.) and is excluded when used outside those approved or compendial indications. Coverage requires diagnosis documentation and specialist prescribing/consultation, relevant labs and antibody testing (examples: PI with IgG below lab normal or ~<250 mg/dL; many secondary indications IgG <600 mg/dL; pediatric HIV <400 mg/dL), evidence of impaired antibody response or recurrent infections (or documented exception), specified prior therapy trials/timing windows (e.g., GBS initiation within 2–4 weeks; refractory myasthenia gravis after immunosuppressants), and demonstration of benefit for reauthorization.

"Post-exposure prophylaxis for varicella when VariZIG not available or cannot be given within 10 days of exposure"