FillMapDental PPO 0-20-50 1500

Does Dental PPO 0-20-50 1500 cover immunoglobulin G?

Dental PPO 0-20-50 1500
10091-10091OR0720004-0 · ACA · ACA Marketplace
immunoglobulin G
immunoglobulin Gunder Dental PPO 0-20-50 1500
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.

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 (60)

  • 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 [Gammaked]Approval first
  • 10 ML immunoglobulin G, human 180 MG/ML InjectionApproval 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 immune globulin intravenous (human) - stwk 100 MG/ML Injection [Alyglo]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Flebogamma]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
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
  • 100 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]Approval first
  • 100 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
  • 100 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]Approval first
  • 100 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]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 100 MG/ML Injection [Octagam]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
  • 20 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]Approval first
  • 200 ML immune globulin intravenous (human) - stwk 100 MG/ML Injection [Alyglo]Approval first
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Flebogamma]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
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Octagam]Approval first
  • 200 ML immunoglobulin G, human 100 MG/ML Injection [Privigen]Approval first
  • 200 ML immunoglobulin G, human 50 MG/ML Injection [Flebogamma]Approval first
  • 200 ML immunoglobulin G, human 50 MG/ML Injection [Gammaplex]Approval first
  • 200 ML immunoglobulin G, human 50 MG/ML Injection [Octagam]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 [Gammaked]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

← All coverage for immunoglobulin G