Immune Globulins for Post-Exposure Prophylaxis (CPB 0544, reviewed 2025-12-23)

REQUIREMENTS: Effective immediately (2025-12-23): Billing team must implement precertification requirements for all immune globulin intramuscular injections (IGIM/GamaSTAN) before claims submission. 1. For Commercial Plans: Contact Aetna specialty pharmacy at (866) 752-7021 (phone) or (888) 267-3277 (fax) to submit precertification requests. Attach Statement of Medical Necessity (SMN) forms available through Specialty Pharmacy Precertification portal. 2. For Medicare Part B Plans: Contact (866) 503-0857 (phone) or (844) 268-7263 (fax) for precertification. 3. Update billing workflows to verify precertification approval BEFORE processing claims for the following approved indications: - Hepatitis B immune globulin: Contact with HBsAg-positive individuals OR prolonged use for HBsAg-positive liver transplant recipients - CMV immune globulin: Transplant recipients meeting specific criteria (renal, lung, liver, pancreas, heart) OR CMV pneumonitis/ganciclovir-resistant disease - Rh-D immune globulin: Pregnancy/post-partum prevention OR ITP treatment OR transfusion suppression - Rabies immune globulin: Animal exposure/bite when animal status unknown or confirmed rabid - Varicella zoster immune globulin: High-risk individuals with significant exposure OR HIV-positive susceptible individuals OR specific HCT recipients - Tetanus immune globulin: Non/incompletely immunized persons with tetanus-prone wounds - Vaccinia immune globulin: Vaccine complications with severe manifestations OR mpox treatment/prophylaxis/adjunctive therapy 4. Providers must document precertification approval in EMR/billing notes before claim submission. All other indications are considered experimental/investigational and will be denied. 5. Failure to obtain precertification will result in claim denials for all IGIM products.