Vyvgart® (efgartigimod alfa-fcab) Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)
EVICORE-MEDICAL_DRUG-F8B6A319
Vyvgart (IV) is covered for adults (≥18) with anti‑AChR antibody–positive generalized myasthenia gravis, and Vyvgart Hytrulo (SC) is covered for adults with anti‑AChR positive gMG and for adults with CIDP; other indications and patients <18 are excluded. Coverage requires neurologist involvement, for gMG documented anti‑AChR positivity, prior/current pyridostigmine use unless failed/contraindicated, MGFA class II–IV and MG‑ADL ≥5, for CIDP electrodiagnostic confirmation and prior IVIG/SCIG failure/intolerance, adherence to specified dosing and 4‑week treatment cycles (do not restart a cycle <50 days), initial approvals (gMG 6 months, CIDP 3 months) and 12‑month renewals based on documented clinical benefit.
"Generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive — Vyvgart (intravenous formulation)."
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