FillMapKP OR Silver 4000 · 71287-71287OR0420012-0About this plan

Does KP OR Silver 4000 cover immunoglobulin G?

1 · Your plan

KP OR Silver 4000

71287-71287OR0420012-0 · ACA · ACA Marketplace

2 · Your medication

immunoglobulin G

immunoglobulin Gunder KP OR Silver 4000

Covered — some forms require prior authorization

5 of 14 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

$75per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

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: Preferred brand
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 (14)

10 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
10 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Amount limit
10 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]
100 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
20 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Amount limit
20 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]
200 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
25 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
300 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]
5 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Amount limit
5 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]
50 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
50 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Amount limit
50 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]Amount limit

← All coverage for immunoglobulin G