MedicaidPrior AuthHigh impact
IVIG (immune globulin) (Revised)
Humana·OH · Allergy & Immunology, Hematology, Oncology +4 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has revised their IVIG (immune globulin) prior authorization policy for Ohio Medicaid, effective January 1, 2026. The policy establishes preferred products and specific criteria for 24 covered conditions including primary immunodeficiency, ITP, and various autoimmune disorders.
Action Required
By January 1, 2026: Review all IVIG prescriptions for Ohio Medicaid patients to ensure they meet the specific criteria outlined in the revised policy. Update prior authorization procedures to use preferred products (Flebogamma DIF, Gammagard, Gammagard S/D, Gammaked, Gamunex-C, Octagam, Privigen, Hizentra, Xembify) unless patient has prior therapy or intolerance with preferred products. Ensure documentation includes diagnosis-specific criteria such as platelet counts for ITP or IgG levels for immunodeficiency. Claims may be denied without proper prior authorization.