Gamifant® (Emapalumab-Lzsg) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Gamifant for primary HLH (refractory/recurrent/progressive disease or intolerance to conventional HLH therapy) and for HLH/MAS in sJIA/AOSD after inadequate response to high‑dose IV glucocorticoids, but not for secondary HLH. Coverage requires medical-record documentation of diagnostic criteria (genetic confirmation or HLH criteria for primary HLH; ferritin >684 ng/mL plus specified lab abnormalities for HLH/MAS), prior treatment failure/intolerance, that primary HLH patients are HSCT candidates and Gamifant is given with dexamethasone, dosing per FDA labeling, and time‑limited authorizations (≤6 months for primary HLH; ≤12 months initial/reauthorization for HLH/MAS) with evidence of clinical response for continuation.

"Treatment of primary hemophagocytic lymphohistiocytosis (HLH) in patients who meet all of the following criteria: Diagnosis of primary hemophagocytic lymphohistiocytosis; and Patient has refractory..."