Publication Date: 

Effective October 1, 2022, the Immunoglobulin Medical Policy will be updated to include preferred products in both the subcutaneous (SC) and intravenous (IV) immune globulin products. Providers must try preferred SC products and IV products before utilizing non-preferred products. This change will only impact patients who are new to therapy. Patients currently in therapy will not be impacted. 

This change applies to all commercial, Administrative Services Only (ASO), and State Health Plan members. This policy does not apply to FEP (Federal Employee Program) or Medicare members. 

Preferred IV products:  Octagam, Gamunex-C, Gammaked, Gammagard Liquid, Privigen 
Preferred SC products:  Hizentra, Xembify