J7637 Insurance Policy Changes

Emapalumab-lzsg (Gamifant) (CPB 0948, reviewed 2025-12-08)

Aetna has updated its clinical policy for Emapalumab-lzsg (Gamifant) to establish coverage criteria for treatment of primary hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) in Still's disease. Billing teams must implement prior authorization requirements and ensure proper TB screening documentation before claims can be processed. This is a new or significantly revised policy (reviewed 2025-12-08) affecting a specialty injectable medication with specific patient eligibility and pre-treatment requirements.