CommercialPrior AuthMedium impact
Efgartigimod Alfa-fcab (Vyvgart®); Efgartigimod Alfa-fcab and Hyaluronidase-qvfc (Vyvgart®Hytrulo)
BCBS Tennessee·TN · Neurology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Vyvgart and Vyvgart Hytrulo (efgartigimod products) used to treat generalized myasthenia gravis and chronic inflammatory demyelinating polyneuropathy. The policy establishes prior authorization requirements, coverage criteria, and quantity limits for these specialty medications.
Action Required
Before June 30, 2026: Billing team must prepare for new prior authorization requirements for Vyvgart and Vyvgart Hytrulo. Update prior auth workflows to collect required documentation including anti-AchR antibody test results, MGFA clinical classification, MG-ADL scores, and previous therapy history for myasthenia gravis patients. For CIDP patients, ensure electrodiagnostic testing results and previous therapy documentation are available. Train staff on the specific coverage criteria and quantity limits for both IV and subcutaneous formulations.