Immune Globulin Intramuscular Injection (GamaSTAN)
EVICORE-MEDICAL_DRUG-F4C3BC69
Covered: GamaSTAN S/D IM is authorized only for FDA‑approved post‑exposure prophylaxis of hepatitis A (exposure ≤2 weeks, asymptomatic or high‑risk), measles (exposure ≤6 days, unvaccinated/no prior disease), varicella (exposure ≤10 days or high‑risk when VarZIG unavailable), and rubella (recent exposure); no off‑label uses meet evidence standards. Key requirements: documentation of exposure timing and clinical/vaccination status, screening for contraindications (isolated IgA deficiency, severe thrombocytopenia/coagulation disorders or any condition precluding IM injection), adherence to dose limits and thrombosis‑risk precautions (hydration, monitoring, assess viscosity), 3‑month deferral of measles vaccine if ≥12 months old after GamaSTAN, and approvals limited to 6 months.
"Prophylaxis of hepatitis A"
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