FillMapMHP Gold Standard

Does MHP Gold Standard cover immunoglobulin G?

MHP Gold Standard
74917-74917MI0020018-0 · ACA · ACA Marketplace
immunoglobulin G
immunoglobulin Gunder MHP Gold Standard
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$250per 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.

Tier
Specialty
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 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Covered forms and strengths (41)

  • 10 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first
  • 10 ML immune globulin subcutaneous (human) - klhw 200 MG/ML Injection [Xembify]Approval first
  • 10 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 10 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
  • 10 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 10 ML immunoglobulin G, human 200 MG/ML Injection [Cuvitru]Approval first
  • 10 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Approval first
  • 10 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard ERC]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 12 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first
  • 20 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first
  • 20 ML immune globulin subcutaneous (human) - klhw 200 MG/ML Injection [Xembify]Approval first
  • 20 ML immunoglobulin G, human 200 MG/ML Injection [Cuvitru]Approval first
  • 20 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Approval first
  • 20 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]Approval first
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 24 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first
  • 25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 25 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 300 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 40 ML immunoglobulin G, human 200 MG/ML Injection [Cuvitru]Approval first
  • 400 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 48 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first
  • 5 ML immune globulin subcutaneous (human) - klhw 200 MG/ML Injection [Xembify]Approval first
  • 5 ML immunoglobulin G, human 200 MG/ML Injection [Cuvitru]Approval first
  • 5 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Approval first
  • 5 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]Approval first
  • 50 ML immune globulin subcutaneous (human) - klhw 200 MG/ML Injection [Xembify]Approval first
  • 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard ERC]Approval first
  • 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]Approval first
  • 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammaked]Approval first
  • 50 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]Approval first
  • 50 ML immunoglobulin G, human 200 MG/ML Injection [Cuvitru]Approval first
  • 50 ML immunoglobulin G, human 200 MG/ML Injection [Hizentra]Approval first
  • 50 ML immunoglobulin G, human 200 MG/ML Prefilled Syringe [Hizentra]Approval first

← All coverage for immunoglobulin G