Imaavy® (nipocalimab-aahu intravenous infusion)

EviCore covers Imaavy (nipocalimab‑aahu IV) only for FDA‑approved generalized myasthenia gravis in patients ≥12 years who are anti‑AChR or anti‑MuSK antibody‑positive and excludes use in patients <12 or for non‑FDA indications. Coverage requires documentation of age and positive antibody status, neurologist prescribing/consultation, prior or current pyridostigmine use (or documented contraindication/intolerance/inadequate response), and—for adults ≥18—MGFA class II–IV with MG‑ADL ≥6; initial approval is 6 months and renewals are 1 year with prescriber documentation of continued benefit.

"Documentation of prior or current pyridostigmine treatment OR documentation of inadequate efficacy, a contraindication, or significant intolerance to pyridostigmine."

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