MedicaidPrior AuthHigh impact
IVIG (immune globulin) (Revised)
Humana·OH · Allergy & Immunology, Hematology, Infectious Disease +5 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Oct 6, 2026
Summary
This is a historical policy document (issued 2026-01-01, discovered 2026-10-06) establishing Humana Medicaid Ohio's IVIG (immune globulin) prior authorization requirements across 25 product formulations and 24 clinical indications. The policy specifies preferred products, step-therapy rules, and approval criteria for conditions ranging from primary immunodeficiency to autoimmune diseases. Since this policy became effective on 2026-01-01 and is now 9 months past implementation, verify current applicability with Humana before applying these requirements.
Action Required
Already effective as of 2026-01-01 (now historical): Verify whether the practice has implemented prior authorization requirements for all IVIG products listed in this Medicaid Ohio policy and confirm current applicability with Humana. Billing team should: (1) Confirm this policy remains current by checking Humana's Medical and Pharmacy Coverage Policies portal before submitting claims; (2) For all IVIG prior authorization requests, apply the specified preferred product hierarchy (Flebogamma DIF, Gammagard, Gammagard S/D, Gammaked, Gamunex-C, Hizentra, Octagam, Privigen, Xembify for medical benefit; Gamunex-C for Medicare Part D); (3) Require documentation of prior therapy or intolerance for non-preferred IVIG products; (4) Obtain BvsD (Brand vs. Generic) Coverage Determination when required; (5) For continuation of prior therapy within past 365 days, waive step-therapy requirement for Medicare Part B requests. Claims submitted without required prior authorization will be denied.