Subcutaneous Immune Globulins (Cuvitru, Hizentra, Hyqvia)

Evicore covers SCIG products (Cutaquig, Cuvitru, Hizentra, Hyqvia, Xembify) for FDA‑approved primary humoral immunodeficiencies and for CIDP maintenance therapy (Hyqvia is excluded for CIDP), with initial and renewal approvals for 12 months. Coverage requires age limits (≥2 years for most SCIGs; ≥18 years for Hyqvia and for CIDP), prescription/consultation by an appropriate specialist (allergist/immunologist/ENT/pulmonologist/infectious disease for PID; neurologist for CIDP), supporting labs/clinical criteria (low IgG plus impaired antibody response or recurrent infections for PID; electrodiagnostic confirmation and documented neurologic improvement for CIDP), and documentation of ongoing benefit for reauthorization.

"Primary humoral immunodeficiency - Other agammaglobulinemia due to absence of B-cells."

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