MA08.142e, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)

By December 31, 2025: Billing team and clinical staff must review MA08.142e policy to understand medical necessity criteria for Vyvgart and Vyvgart Hytrulo. Coordinate with providers and pharmacy to ensure all claims submissions include appropriate documentation supporting medical necessity per policy guidelines. Update prior authorization processes if required by the policy. Establish internal communication protocol to flag claims for these biologics and verify compliance with criteria before billing to Medicare Advantage plans. Failure to meet medical necessity requirements will result in claim denials.