FillMap15983pa0030004 · 15983-15983PA0030004-0About this plan

Does 15983pa0030004 cover lymphocyte immune globulin, anti-thymocyte globulin?

1 · Your plan

15983pa0030004

15983-15983PA0030004-0 · ACA · ACA Marketplace

2 · Your medication

lymphocyte immune globulin, anti-thymocyte globulin

lymphocyte immune globulin, anti-thymocyte globulinunder 15983pa0030004

Covered — requires prior authorization

Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.

Tier: Specialty drugs
Approval first: Required
Try another first: No
Amount limit: Yes

Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (2)

5 ML lymphocyte immune globulin, anti-thymocyte globulin, equine 50 MG/ML Injection [ATGAM]Approval firstAmount limit
rabbit anti-human T-lymphocyte globulin 25 MG Injection [Thymoglobulin]Approval firstAmount limit

← All coverage for lymphocyte immune globulin, anti-thymocyte globulin