Subcutaneous Immune Globulin
EVICORE-MEDICAL_DRUG-F7DC8789
Subcutaneous immune globulin (Cutaquig, Cuvitru, Hizentra, Hyqvia, Xembify) is covered for FDA‑approved indications—primarily primary humoral immunodeficiencies (e.g., CVID, XLA, SCID, IgG subclass deficiency, SAD) and as maintenance therapy for CIDP—with Hyqvia restricted to adults (≥18) and Hyqvia excluded for CIDP. Coverage requires documented diagnosis and specialist involvement, supporting laboratory or electrodiagnostic evidence (age‑adjusted low total IgG and/or impaired antibody response—with pre/post‑vaccination testing unless harmful—or recurrent infections for PID; electrodiagnostic confirmation and neurologist oversight for CIDP), initial and renewals are for 12 months, and reauthorization requires documentation of ongoing benefit (e.g., increased IgG, infection control, or clinically significant neurological improvement).
"Subcutaneous immune globulin (SCIG) injection is indicated for the treatment of: Primary humoral immunodeficiency including but not limited to, congenital agammaglobulinemia, common variable immuno..."