Efgartigimod (Vyvgart)

Vyvgart (efgartigimod) is covered only for FDA‑approved use in adults (≥18) with anti‑AChR antibody‑positive generalized myasthenia gravis and is excluded for AChR‑negative patients, those <18, or non‑FDA/non‑compendial uses. Coverage requires MGFA class II–IV, MG‑ADL ≥5, unresolved gMG symptoms, prior/current pyridostigmine use or documented intolerance, neurologist prescription/consultation, weight documentation for dosing (10 mg/kg or 1200 mg if ≥120 kg), initial approval 6 months (renewals 12 months) with documented clinical benefit and subsequent cycles generally not begun sooner than 50 days.

"Documentation of Myasthenia Gravis Foundation of America (MGFA) classification II to IV."

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