MedicaidPrior AuthHigh impact
IVIG (immune globulin) (New)
Humana·VA · Hematology, Oncology, Allergy & Immunology +5 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana implemented a new comprehensive prior authorization policy for IVIG (immune globulin) products effective January 1, 2026, covering 25+ medical conditions including primary immunodeficiency, ITP, CLL, and various autoimmune disorders. The policy establishes specific coverage criteria, preferred product lists, and step therapy requirements for Virginia Medicaid patients.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all IVIG products (Hizentra, Hyqvia, Cuvitru, Cutaquig, Xembify, GamaSTAN) for Virginia Medicaid patients. Update billing system to flag IVIG orders requiring prior auth documentation including specific diagnosis criteria, lab values (IgG levels), and preferred product usage. Train providers on preferred product lists and step therapy requirements. Claims without proper prior authorization will be denied.