Subcutaneous Immune Globulins (Cuvitru, Hizentra, Hyqvia)

Covers listed SCIGs (Cutaquig, Cuvitru, Hizentra, Hyqvia, Xembify) for FDA‑approved indications—primarily specified primary humoral immunodeficiencies and CIDP maintenance—with product/age exclusions (Hyqvia limited to adult initial use and excluded for some pediatric indications). Coverage requires specialist prescribing/consultation, age eligibility, supporting documentation (age‑adjusted low IgG plus impaired antibody response or recurrent infections for PID; electrodiagnostic confirmation for CIDP), proof of clinical benefit for reauthorization, and approvals are issued for 12 months.

"Must have one of the following subtypes of primary immunodeficiencies: Congenital agammaglobulinemia"

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