Medicare Part D coverage · 200 · RxCUI 1876674
200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]
Per the CMS 2026 Part D formulary file, 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] is covered by 1,074 Medicare Part D plans (21.3% of enrollable products), averaging Tier 4.2, with prior authorization required on 100% of covering formularies.
- 21.3%
- Plan coverage
- 1,074
- Plans covering
- T4.2
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]
Per the CMS 2026 Part D formulary file, 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] (RxNorm concept RXCUI 1876674, generic name 200) appears on 110 distinct formulary files spanning 1,074 Medicare Part D plan offerings - 21.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.2.
Real-world access to 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 40 Part D beneficiaries filled 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] in 2023, with total plan-and-beneficiary spending of $5,071,918 and an average per-beneficiary annual cost of $126,797.94. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] today.
Coverage Details
- Formularies covering
- 110
- Plans covering
- 1,074
- Coverage rate
- 21.3%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 40
- Total spending
- $5,071,918
- Avg per beneficiary
- $126,797.94
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
Show the next 30 plans
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | Yes | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | Viva Health, Inc. | T1 | Yes | $27.70 | AL |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | Elderplan, Inc. | T1 | Yes | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | Metroplus Health Plan, Inc. | T1 | Yes | $58.80 | NY |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T2 | Yes | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T2 | Yes | $0 | CA |
| BlueCare Plus (HMO D-SNP) | Volunteer State Health Plan | T4 | Yes | $0 | TN |
| BlueCare Plus Choice (HMO D-SNP) | Volunteer State Health Plan | T4 | Yes | $0 | TN |
| BlueCare Plus Select (HMO D-SNP) | Volunteer State Health Plan | T4 | Yes | $0 | TN |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T4 | Yes | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T4 | Yes | $0 | NY |
| Leon MediExtra (HMO) | Leon Health, Inc. | T4 | Yes | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T4 | Yes | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] covered by Medicare Part D?
Yes, 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] is covered by 1,074 Medicare Part D plans (21.3% of all Part D formularies).
What tier is 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] on Medicare Part D plans?
200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 6.
Does 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] require prior authorization?
100% of Part D formularies require prior authorization for 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]?
In 2023, total Medicare Part D spending on 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex] was $5,071,918, covering 40 beneficiaries. The average spend per beneficiary was $126,797.94.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- aripiprazole 2 MG Oral Film [Opipza] T4.2
- 2.4 ML aripiprazole lauroxil 281.3 MG/ML Prefilled Syringe [Aristada] T4.2
- 1 ML benralizumab 30 MG/ML Auto-Injector [Fasenra] T4.2
- {7 (24 HR deutetrabenazine 12 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 18 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 24 MG Extended Release Oral Tablet [Austedo]) / 7 (24 HR deutetrabenazine 30 MG Extended Release Oral Tablet [Austedo]) } Pack [Austedo XR Once Daily, 4 Week Titration Pack, 12 MG / 18 MG / 24 MG / 30 MG] T4.2
- abiraterone acetate 500 MG Oral Tablet T4.2
- glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret] T4.2
Similar prior-authorization rate
- azathioprine 50 MG Oral Tablet 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B] 100% PA
- 0.5 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- 1 ML hepatitis B surface antigen vaccine 0.02 MG/ML Prefilled Syringe [Engerix-B] 100% PA
- sotagliflozin 200 MG Oral Tablet [Inpefa] 100% PA
- mycophenolate mofetil 250 MG Oral Capsule 100% PA