Immune Globulin (IVIG and SCIG) – Commercial Medical Benefit Drug Policyopen_in_new

IVIG/SCIG is covered as medically necessary for a defined list of conditions (primarily primary immunodeficiencies and select hematologic, neurologic, dermatologic, infectious and transplant-related indications) while many other uses are designated unproven/not medically necessary and some products (e.g., Alyglo, Asceniv, Panzyga; Yimmugo under review) are excluded or subject to coverage review. Key requirements include detailed documentation (diagnosis, H&P, labs such as IgG or platelet counts, EDX when indicated), specialist involvement, prescriber attestation that dosing follows FDA labeling or published evidence, proof of prior therapy failure/intolerance when required, and authorizations limited to up to 12 months.

"Acute disseminated encephalomyelitis (ADEM)"

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