200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]

Verify with CMS →

immunoglobulin G, human

RxCUI: 1809513

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
23.1%
Plan Coverage
1,173
Plans Covering
T4.2
Avg Tier
98.1%
Prior Auth Required

What the CMS Formulary Data Shows for 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]

Per the CMS 2026 Part D formulary file, 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex] (RxNorm concept RXCUI 1809513, generic name immunoglobulin G, human) appears on 106 distinct formulary files spanning 1,173 Medicare Part D plan offerings - 23.1% 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 50 MG/ML Injection [Gammaplex] depends on utilization management as much as tier placement: 98.1% 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 50 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 50 MG/ML Injection [Gammaplex] today.

Coverage Details

Formularies covering
106
Plans covering
1,173
Coverage rate
23.1%
Tier range
Tier 1 – Tier 6
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
98.1% 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

39 plans
Tier 1, Preferred Generic
1 plans
Tier 2, Generic
6 plans
Tier 3, Preferred Brand
7 plans
Tier 4, Non-Preferred
47 plans
Tier 5, Specialty

Medicare Advantage Plans (MA-PD) Covering 200 ML immunoglobulin G, human 50 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
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
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
CalOptima Health OneCare Complete (HMO D-SNP) ORANGE COUNTY HEALTH AUTHORITY T2 Yes $0 CA
Óptimo Plus (PPO) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
Contigo Plus (HMO C-SNP) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
Brillante (HMO-POS) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
Enlace Plus (HMO) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
ContigoEnMente (HMO C-SNP) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
Ahorro Plus (HMO) TRIPLE S ADVANTAGE, INC. T3 Yes $0 PR
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
Leon MediExtra (HMO) LEON HEALTH, INC. T4 Yes $0 FL

Frequently Asked Questions

Is 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex] covered by Medicare Part D?

Yes, 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex] is covered by 1,173 Medicare Part D plans (23.1% of all Part D formularies).

What tier is 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex] on Medicare Part D plans?

200 ML immunoglobulin G, human 50 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 50 MG/ML Injection [Gammaplex] require prior authorization?

98.1% of Part D formularies require prior authorization for 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]?

In 2023, total Medicare Part D spending on 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex] was $5,071,918, covering 40 beneficiaries. The average spend per beneficiary was $126,797.94.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial