Medicare AdvantagePrior AuthHigh impact
IVIG (immune globulin)
Humana·KY, SC · Allergy & Immunology, Hematology, Oncology +5 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a comprehensive prior authorization policy for IVIG (immune globulin) products effective January 1, 2026, covering multiple Medicare and Medicaid lines of business. The policy establishes preferred product lists, specific clinical criteria for 25+ medical conditions, and requires prior authorization for all IVIG treatments with detailed approval criteria for each indication.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all IVIG products before administering treatments. Update systems to flag preferred products (Flebogamma DIF, Gammagard, Gammagard S/D, Gammaked, Gamunex-C, Octagam, Privigen) and require documentation of specific clinical criteria for each indication. Providers must document qualifying diagnoses, lab values (IgG levels), prior treatments, and platelet counts where applicable. Claims without proper prior authorization will be denied.