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IVIG (immune globulin) (Revised)
Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jul 21, 2026
Summary
Humana revised its IVIG (immune globulin) pharmacy coverage policy effective January 1, 2026, with updates as of July 22, 2026. The policy clarifies prior authorization requirements, preferred product selections, and clinical criteria for coverage across 24 IVIG formulations for Medicare and Medicaid (Kentucky and South Carolina) members. Key requirements include step therapy with preferred products unless prior therapy/intolerance documented, specific clinical thresholds (e.g., IgG levels, platelet counts), and condition-specific approval criteria for 22 listed indications.
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What to do
by Jan 1, 2026 · 8 steps
01Billing team must implement prior authorization requirements in billing software for all IVIG claims (J-codes listed above) for Kentucky and South Carolina Medicaid and Medicare members.
02Update claims submission protocols to enforce step therapy: require documentation of prior therapy or documented intolerance when non-preferred products (Hizentra, Gammaked, Gamunex-C, Hyqvia, Cuvitru, Panzyga, Cutaquig, Xembify, Asceniv, Bivigam, Alyglo, Gammaplex, Yimmugo, Qivigy, GamaSTAN) are requested.
03For continuation therapy within 365 days on Medicare Part B, bypass step therapy requirement.
04Preferred products are: Flebogamma DIF, Gammagard, Gammagard S/D, Gammaked, Gamunex-C (Medicare Part D primary), Hizentra, Octagam, Privigen, and Xembify.
05Prior to submission, clinical staff must verify member meets indication-specific criteria (documented diagnosis, required lab values per indication: IgG thresholds ranging 400-600 mg/dL, platelet counts, etc.).
06BvsD (Brand vs. Generic) coverage determination may be required—verify in system before authorization.
07Failure to obtain prior authorization will result in claim denials.
08Notify providers of updated requirements and preferred product list.
Codes mentioned
J1551J1556J1557J1559J1561J1562J1566J1568J1569J1572J1575J1576J1580J1581J1592J1599J1670J1673J1674J1688J1696J1700J1711J1714
Original notice
IVIG (immune globulin) (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →IVIG (immune globulin) (Revised)HighEffective Jan 1, 2026 · MedicaidIVIG (immune globulin) (Revised)HighEffective Jul 1, 2024 · MedicaidIVIG (immune globulin) (Revised)HighEffective Jan 1, 2026 · MedicaidIVIG (immune globulin)HighEffective Jan 1, 2026 · MedicaidBrowse every Humana change in the policy list
Related policy hubs
Humana policiesKY policy changesSC policy changesHematologyInfectious DiseaseNeurologyOncologyPediatricsRheumatologyTransplant SurgeryCode J1551Code J1556Code J1557Code J1559Code J1561Code J1562Code J1566Code J1568Code J1569Code J1572Code J1575Code J1576Code J1580Code J1581Code J1592Code J1599Code J1670Code J1673Code J1674Code J1688Code J1696Code J1700Code J1711Code J1714