[
Independence has changed how we manage subcutaneous immunoglobulin (SCIG)
for members enrolled in our commercial medical benefit plans. 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.
As of October 1, 2017, Independence updated 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 Independence
patients?
IVIG and SCIG products will continue to be eligible for coverage in
accordance with the criteria listed in the Independence 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 became effective October 1, 2017.
To view this policy, visit our Medical Policy Portal.
Select Accept and Go to Medical Policy Online, then select the
Commercial tab from the top of the page and type the policy name or
number in the Search field.
]