Intravenous Immune Globulin Injection
EVICORE-MEDICAL_DRUG-5F3C1CE4
IVIG is covered for a broad set of FDA‑approved and compendial off‑label indications (e.g., primary and secondary humoral immunodeficiencies such as CVID, XLA, SCID; ITP; CIDP; MMN; Kawasaki disease; transplant ABMR/desensitization; multiple neurologic and autoimmune disorders; post‑exposure measles/varicella prophylaxis) and is not covered for uses that are neither FDA‑approved nor compendia‑supported. Coverage requires indication‑specific documentation and criteria — including baseline testing and IgG thresholds where specified (e.g., <500 mg/dL for many secondary hypogammaglobulinemias, <400 mg/dL for pediatric HIV, <250 mg/dL cited for some PIDs), specialist prescribing/consultation, required prior therapy trials or timing limits (e.g., steroids/immunosuppressants for autoimmune diseases, electrodiagnostic confirmation for CIDP, prior corticosteroid trial for ITP unless urgent), and documentation of treatment response and dosing/authorization duration.