Does Devoted Choice Giveback 002 Ok (PPO) cover immunoglobulin G?
Devoted Choice Giveback 002 Ok (PPO)
H2845-002-0 · MA_LOCAL · Medicare Part D
immunoglobulin G
Do you get help with your Medicare drug costs?None of these
Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.
immunoglobulin Gunder Devoted Choice Giveback 002 Ok (PPO)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
25%of the price your plan negotiates
Medicare hasn’t published this plan’s negotiated price for this drug yet — that file is updated every three months, and newly launched drugs appear in it late. Your pharmacy can quote the exact amount today. Part D caps what you pay out of pocket at $2,100 for 2026. Before that, you pay the full price until you have paid $605 this year.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
- Tier
- Tier 5
- Approval first
- Required
- Try another first
- No
- Amount limit
- None
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 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.
Covered forms and strengths (23)
- 10 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 10 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Tier 5Approval first
- 10 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Tier 5Approval first
- 100 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard ERC]Tier 5Approval first
- 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Tier 5Approval first
- 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]Tier 5Approval first
- 20 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Tier 5Approval first
- 20 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Tier 5Approval first
- 200 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]Tier 5Approval first
- 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]Tier 5Approval first
- 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]Tier 5Approval first
- 25 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Tier 5Approval first
- 300 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 50 ML immune globulin intravenous (human) - ifas 100 MG/ML Injection [Panzyga]Tier 5Approval first
- 50 ML immunoglobulin G, human 100 MG/ML Injection [Bivigam]Tier 5Approval first
- 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard ERC]Tier 5Approval first
- 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Tier 5Approval first
- 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammaplex]Tier 5Approval first
- immunoglobulin G, human 10000 MG Injection [Gammagard]Tier 5Approval first
- immunoglobulin G, human 5000 MG Injection [Gammagard]Tier 5Approval first