Most public and private payers – such as Medicare, Medicaid, and managed care plans – will cover IgG treatments for labeled indications as approved by the U.S. Food and Drug Administration (FDA). Specific patient benefits, however, will vary among third-party payers.
Although infusions of drugs and biologics are often covered by payers as part of their benefits, some payers may require prior authorization (PA). To satisfy PA or medical necessity requirements for a particular patient, a payer may request the following types of information:
- Detailed information on the patient’s medical condition and treatment history
- A statement or letter of medical necessity
- The product’s Prescribing Information/Package Insert
- The product’s FDA approval letter
- The patient’s weight
- The product’s dosage
- The frequency of administration
Learn more about Medical Coding.
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