Efgartigimod alfa-fcab or Efgartigimod alfa and hyaluronidase-qvfc

This policy covers efgartigimod alfa‑fcab (and efgartigimod alfa with hyaluronidase‑qvfc) for treatment of CIDP and generalized myasthenia gravis (MG) when use is supported by FDA labeling, nationally recognized compendia, or high‑quality peer‑reviewed literature. Coverage is limited to adults (≥18 years) and requires documented prior treatment failures or contraindications (CIDP: prior failure/contraindication to immunoglobulin and corticosteroids; MG: anti‑AChR seropositivity, MGFA Class II–IV with MG‑ADL ≥5, and inadequate response/intolerance to an acetylcholinesterase inhibitor and at least one immunosuppressant), prohibits concurrent use with other MG biologics, and remains subject to member benefit/contract exclusions and criteria.

"Therapies are covered when proven effective for the relevant diagnosis or procedure based on peer-reviewed scientific literature or other accepted standards of practice."