Access to SCIG restored for PI patients in recent Anthem update

In July 2026, Carelon, a healthcare subsidiary of Elevance Health (formerly Anthem), removed its intravenous immunoglobulin (IVIG) fail-first requirement from Anthem Blue Cross and Blue Shield (BCBS) health plans ¹. This change restores access to subcutaneous immunoglobulin (SCIG) therapy for people with primary immunodeficiency (PI).

Earlier this year, Anthem BCBS initiated a policy that required patients, including those already stabilized on SCIG, to try and fail or demonstrate intolerance to IVIG before gaining access to preferred SCIG products. In response, the Immune Deficiency Foundation took action, urging Anthem BCBS to reverse this requirement because it threatened patient treatment continuity and health.

As a result of our advocacy, Anthem BCBS has removed the IVIG step-therapy requirement. Patients can now access preferred SCIG therapies without first having to try and demonstrate intolerance to IVIG. This policy change protects individuals who are stable on SCIG from unnecessary treatment changes and the risk of serious health complications.

The former Anthem BCBS IVIG fail-first coverage policy

Under Anthem BCBS's previous policy, patients seeking coverage for preferred SCIG products were required to show that they had already tried IVIG and either did not respond adequately or could not tolerate treatment. Importantly, this requirement applied to both new and existing patients, including those who had previously been receiving SCIG without such restrictions.

What this meant for patients

This fail-first requirement was more restrictive than any previous Anthem BCBS Ig policy. Patients who were stable on SCIG but had never completed an IVIG trial faced potential coverage challenges during plan renewals. This included some who had effectively been “grandfathered” into treatment in prior years. For people with PI, unnecessary changes in routes of administration can increase the risk of treatment interruptions, reduce medication adherence, and lead to adverse health outcomes.

The current Anthem BCBS coverage policy for SCIG products

The updated Anthem BCBS policy represents a significant improvement for the PI community. Anthem BCBS has removed the requirement that patients must first try IVIG before accessing preferred SCIG therapies. SCIG is now available as a first-line immunoglobulin treatment option under the new policy.

Patients seeking coverage for a non-preferred SCIG product may still need to meet additional requirements. Still, these now occur within the SCIG category rather than first requiring a trial of IVIG.

What this means for patients

Anthem BCBS' policy change removes the barrier that previously limited access to SCIG for new and existing patients. People with PI can now begin or continue treatment with preferred SCIG products without first demonstrating failure or intolerance to IVIG. This policy change restoring SCIG access is a meaningful victory for patient choice, treatment continuity, and access to appropriate care.

How we continue to address treatment access barriers

We continue to monitor the implementation of Anthem BCBS' updated policy and advocate on behalf of the PI community as access concerns arise.

We encourage patients facing access barriers with any insurer to contact the advocacy team at contact Ask IDF and provide a detailed description of the issue so we can better understand and address emerging roadblocks to care.

¹ Anthem BCBS plans are in the following states: CA, CO, CT, IN, GA, KY, ME, MO, NV, NH, NY, OH, VA, WI