Intravenous Immune Globulin Injection
EVICORE-MEDICAL_DRUG-63204283
Covers IVIG for FDA‑approved and specified compendial uses (e.g., primary/secondary humoral immunodeficiency, ITP, CIDP, MMN, Kawasaki, GBS, myasthenia gravis, dermatomyositis, and post‑exposure measles/varicella) with exclusions for product‑specific safety contraindications (e.g., Privigen in hyperprolinemia, and restrictions for patients with IgA deficiency/anti‑IgA and hypersensitivity). Key requirements include indication‑specific documentation (initial serum IgG <400 mg/dL for primary/secondary immunodeficiency; reauthorization requires decreased infections or clinical improvement/stability for many disorders), evidence disease is refractory to standard therapies for certain indications, PEP timing/availability criteria for measles/varicella, adherence to weight‑based dosing, and typical approval durations of 6 months (or one‑dose/30 days for PEP).
"Post-exposure prophylaxis of varicella (compendial use)"