Subcutaneous Immune Globulins (Cuvitru, Hizentra, Hyqvia)

Evicore covers subcutaneous immune globulins (Cutaquig, Cuvitru, Hizentra, Hyqvia, Xembify) for FDA‑approved primary humoral immunodeficiencies and as maintenance therapy for CIDP (Hyqvia is excluded for CIDP; Hyqvia initial use is limited to ≥18 years; CVID/unspecified IgG indications [excluding Hyqvia] require ≥2 years). Coverage requires specialist prescribing/consultation (allergist/immunologist/ENT/pulmonologist/infectious disease for PID; neurologist for CIDP), documented diagnosis and age, serum IgG (and IgA/IgM where applicable) below age‑adjusted normal on ≥2 occasions >3 weeks apart, markedly impaired antibody responses (or documentation that delaying testing would be harmful), exclusion/treatment of other infection risks, prior IG dosing when switching, demonstration of clinical benefit for reauthorization, and approvals are issued for up to 12 months.

"Hyqvia: initial authorization requests limited to individuals 18 years of age or older (Hyqvia only)."