IVIG - BMC HealthNet Plan

32. Multiple Sclerosis, post-partum to prevent relapses. Approve IVIG for 6 months
for women in the post partum period who are not currently receiving therapy with
disease modifying treatments ([DMT] e.g., interferon beta-1a injection, intramuscular
[Avonex ® ], interferon beta-1a injection, subcutaneous [Rebif ® ], interferon beta-1b
injection [Betaseron ® , Extavia ® ], glatiramer acetate injection [Copaxone ® ],
fingolimod capsules [Gilenya], natalizumab injection [Tysabri ® ], mitoxantrone
injection [Novantrone ® ]) to prevent relapses of MS. None of the DMTs have been
approved for use in women who are nursing; IVIG is safe for use in nursing
mothers. 82
It has been documented that there is an increase in relapse during the initial three
months after birth which may continue for up to 6 months (in patients not receiving
therapy). 83-85 In a randomized, confirmatory, multicenter, double-blinded-placeboperiod
(days 1-3 post-partum) trial, women with clinically confirmed relapsing
remitting MS and at least one relapse within the 2 years prior to pregnancy received
treatment with IVIG (IVIG 150 mg/kg day 1 post-partum followed by placebo
injections on days 2 and 3 [Group I], or IVIG 900 mg/kg over a 3 day period [Group
II]). 182 Initial IVIG treatment was followed by an open phase in which both groups
received five doses of IVIG (150 mg/kg) at monthly (every 4 week) intervals. Prior to
pregnancy the number of relapses per women per year in the 2 years prior to
pregnancy was 1.0 ± 0.7 and 1.0 ± 0.6 in Group I and Group II, respectively. In
Groups I and II, 75.6% and 81.5% of patients respectively, remained relapse-free
during the 3 month post-partum period (primary efficacy endpoint). The difference
between the groups (6%) at three months was not statistically significant (P =
0.2353). Numerically more patients in Group II remained relapse-free compared with
Group I between months 4 to 6 (82.3% vs. 70.9%) and within the total observation
period of 6 months (69.1% vs. 57.5%); none of these differences reached statistical
significance between groups.
Steroids may be used to treat acute relapses during pregnancy and in the post-partum
period in nursing women (see Multiple Sclerosis, acute severe exacerbation).
IVIG is not recommended for maintenance treatment to prevent relapses (see
Exclusions).
33. Myasthenia gravis. Approve IVIG for 1 course of treatment (up to 5 days) in
patients who meet the following criteria (A and B). Note: IVIG is used for severe
exacerbations and as a short-term measure. Some patients may require additional
courses of therapy, but IVIG is not appropriate for maintenance therapy in
myasthenia gravis.
A. IVIG is prescribed by or in consultation with a neurologist who is specialized
or experienced in the treatment of neuromuscular diseases, 86 and
B. The patient meets one of the following criteria (a, b, c, or d).
This guideline provides information on BMC HealthNet Plan claims adjudication processing guidelines. The use of this
guideline is not a guarantee of payment and will not determine how a specific claim(s) will be paid. Reimbursement is
based on member benefits and eligibility, medical necessity review, where applicable, coordination of benefits, adherence
to Plan policies, clinical coding criteria, and the BMC HealthNet Plan agreement with the rendering or dispensing provider.
Reimbursement policies may be amended at BMC HealthNet Plan’s discretion. BMC HealthNet Plan will always use the
most recent CPT and HCPCS coding guidelines.
BMC HealthNet Plan – IVIG
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