AmeriHealth is changing how we manage subcutaneous immunoglobulin (SCIG) for members enrolled in our commercial products. There are various SCIG products on the market, and there is no reliable evidence that demonstrates the superiority of one product over the others. However, there are notable differences in cost.

Effective October 1, 2017, AmeriHealth will update Medical Policy #08.00.13s: Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG) to reflect that Gammagard^® Liquid, Gammaked^®, and Gamunex-C^® are the designated preferred products for SCIG. These preferred products were selected based on their demonstrated cost-effectiveness. Choosing a preferred product does not affect the member?s cost-sharing for the drug.

Coverage requests for non-preferred SCIG products including, but not limited to Cuvitru^®, Hizentra^®, and HyQvia will only be considered if the member has a documented failure, intolerance, or contraindication to a preferred SCIG product.

What does this mean for your AmeriHealth patients?

IVIG and SCIG products will continue to be eligible for coverage in accordance with the criteria listed in the AmeriHealth medical policy.

Coverage requests for preferred SCIG products (i.e., Gammagard^® Liquid, Gammaked^®, Gamunex-C^®) will be considered if the member meets the criteria in our medical policy.

Members who have a current precertification approval for Cuvitru^®, Hizentra^®, or HyQvia can continue treatment with their existing regimen. However, new coverage requests for non-preferred SCIG products will only be considered if the member meets the criteria in our medical policy and has a documented failure, contraindication, or intolerance to a preferred SCIG product. Providers may be asked to submit medical documentation to support these coverage requests.

Note: Members who are receiving IVIG products are not affected by these changes.

More information

To learn more, review Medical Policy #08.00.13s: Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG), which will be posted as a Notification on June 30, 2017, and will become effective October 1, 2017.

To view the Notification for this policy, visit our Medical Policy Portal on or after June 30, 2017. Select Accept and Go to Medical Policy Online, then select Commercial under Active Notifications.