Pemivibart

This policy addresses pemivibart (Pemgarda) for pre‑exposure prophylaxis of COVID‑19 in adults and adolescents ≥12 years and ≥40 kg who are moderately to severely immunocompromised, unlikely to mount an adequate vaccine response, and are not currently infected or recently exposed to SARS‑CoV‑2. Use is limited to the March 22, 2024 FDA Emergency Use Authorization and must follow EUA conditions and authoritative dosing recommendations; pemivibart is considered investigational/not FDA‑approved for other uses (not authorized for treatment or post‑exposure prophylaxis) and coverage is subject to the member’s benefit plan.

"Therapies must be proven effective for the relevant diagnosis or procedure to be considered for coverage."

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