Medicare AdvantageCoverageMedium impact
MA08.142e, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)
Independence Blue Cross·Neurology, Internal Medicine, Family Medicine·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated medical necessity criteria for efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo), which are treatments for myasthenia gravis and other neuromuscular conditions. The policy changes the requirements that must be met to demonstrate medical necessity for coverage of these specialty medications.
Action Required
Before January 1, 2026: Billing and clinical teams must review the updated medical necessity criteria for Vyvgart and Vyvgart Hytrulo. Update prior authorization workflows and ensure providers document all required criteria when prescribing these medications for Medicare Advantage patients. Failure to meet updated criteria may result in coverage denials.