200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]
immunoglobulin G, human
RxCUI: 1809520
What the CMS Formulary Data Shows for 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]
Per the CMS 2026 Part D formulary file, 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] (RxNorm concept RXCUI 1809520, generic name immunoglobulin G, human) appears on 166 distinct formulary files spanning 1,835 Medicare Part D plan offerings - 36.2% 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 [Privigen] 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 3,071 Part D beneficiaries filled 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] in 2023, with total plan-and-beneficiary spending of $381,709,147 and an average per-beneficiary annual cost of $124,294.74. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] today.
Coverage Details
- Formularies covering
- 166
- Plans covering
- 1,835
- Coverage rate
- 36.2%
- 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
- 3,071
- Total spending
- $381,709,147
- Avg per beneficiary
- $124,294.74
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]
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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | Yes | $0 | AL |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | Yes | $0 | MA |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | Yes | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | Yes | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | Yes | $0 | MO |
| 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 |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE FLORIDA, INC. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | PROCARE ADVANTAGE, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | PROCARE ADVANTAGE, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | AMERICAN HEALTH PLAN OF FL, INC. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | SECUR INC | T1 | Yes | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | SECUR INC | T1 | Yes | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | Yes | $4.80 | TX |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | MARQUIS ADVANTAGE, INC. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE CALIFORNIA INC. | T1 | Yes | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | LIBERTY ADVANTAGE, LLC | T1 | Yes | $14.70 | NC |
Frequently Asked Questions
Is 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] covered by Medicare Part D?
Yes, 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] is covered by 1,835 Medicare Part D plans (36.2% of all Part D formularies).
What tier is 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] on Medicare Part D plans?
200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] 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 [Privigen] require prior authorization?
100% of Part D formularies require prior authorization for 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]?
In 2023, total Medicare Part D spending on 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen] was $381,709,147, covering 3,071 beneficiaries. The average spend per beneficiary was $124,294.74.
Read our methodology - how this data is sourced, computed, and verified.