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IgIQ RESOURCE CENTER BENEFITS INVESTIGATION REQUEST PRESCRIPTION REFERRAL FORM FAX: 1-866-720-4373 TOLL-FREE: 1-877-355-IGIQ (4447) Please complete this form and submit via fax. The IgIQ Resource.

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For the treatment of: Primary humoral immunodeficiency; Chronic immune thrombocytopenic purpura (ITP) in patients age 15 years and older; Chronic inflammatory demyelinating polyneuropathy (CIDP) in adults.

Privigen may be administered as a maintenance infusion of 1 g/kg (10 mL/kg) administered in a single infusion given in one day or divided into two doses given on two consecutive days, every 3 weeks.

Privigen is a medicine used to support the immune system (the body's natural defences) in two main groups of patients: Patients who are at risk of infection because they do not have enough antibodies (also called immunoglobulins, proteins in the blood that help the body to fight disease).

Privigen was licensed in the United States in 2007. Privigen is approved in the United States, Canada, Switzerland, and the European Union (EU) for the treatment of primary humoral immunodeficiency (PHID) and chronic immune thrombocytopenic purpura (ITP).

Privigen has been approved to treat CIDP in Europe since 2013. In the U.S., Privigen is also approved for primary humoral immunodeficiency (PI) and chronic immune thrombocytopenic purpura (ITP) in patients age 15 years and older.

Code. Description. J1459. INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG.

The primary antibody found in Privigen, immunoglobulin G, is the main type of antibody made by your immune system. Your doctor may refer to your Privigen treatment as "Ig," "intravenous Ig," or "IVIg."

Privigen belongs to a class of drugs called Immune Globulins.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232