CommercialCoverageMedium impact
08.01.84e, Efgartigimod alfa - fcab (Vyvgart)
Independence Blue Cross·Neurology, Internal Medicine·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
The medical necessity criteria for Efgartigimod alfa-fcab (Vyvgart) has been updated for commercial insurance plans. This affects billing and coverage determination for this specialized medication used to treat myasthenia gravis.
Action Required
Before January 1, 2026: Review updated medical necessity criteria for Vyvgart (efgartigimod alfa-fcab). Providers must ensure documentation meets new criteria requirements when prescribing this medication. Update prior authorization request processes and clinical documentation templates to align with revised criteria. Claims may be denied if new medical necessity requirements are not met.