Interferon Gamma-1b (Actimmune)

Actimmune (interferon gamma‑1b) is covered only for its FDA‑approved indications—reducing infections in chronic granulomatous disease and delaying progression of severe malignant osteopetrosis—and is excluded for patients with known hypersensitivity to interferon gamma, E. coli‑derived products, or any component. Coverage requires documented FDA‑approved diagnosis, documentation of absence of hypersensitivity, dosing calculations by body surface area or weight with subcutaneous administration, and is authorized for up to 12 months.

"Reducing the frequency and severity of serious infections associated with chronic granulomatous disease (CGD)"

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