High impact
Nipocalimab-aahu (Imaavy) (CPB 1083, reviewed 2026-08-11)
Aetna·Effective Aug 11, 2026
Aetna has issued a new medical policy (CPB 1083, effective 2026-08-11) establishing coverage criteria for nipocalimab-aahu (Imaavy), a neonatal Fc receptor blocker for generalized myasthenia gravis. The policy requires precertification, neurologist prescription, and specific clinical criteria including antibody positivity, MGFA classification II-IV, MG-ADL score ≥5, and documented failure of at least two immunosuppressive therapies or one immunosuppressive therapy plus IVIG over 12 months. Billing teams must implement precertification requirements and ensure claims are submitted under HCPCS code J9256 only when all criteria are met.