FillMapPacificSource Oregon Standard Gold Plan Core

Does PacificSource Oregon Standard Gold Plan Core cover immunoglobulin G?

PacificSource Oregon Standard Gold Plan Core
10091-10091OR0770007-0 · ACA · ACA Marketplace
immunoglobulin G
immunoglobulin Gunder PacificSource Oregon Standard Gold Plan Core
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
50%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. 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 (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