FillMapProvidence Oregon Standard Gold Plan - Choice Network · 56707-56707OR1320004-0About this plan

Does Providence Oregon Standard Gold Plan - Choice Network cover immunoglobulin G?

1 · Your plan

Providence Oregon Standard Gold Plan - Choice Network

56707-56707OR1320004-0 · ACA · ACA Marketplace

2 · Your medication

immunoglobulin G

immunoglobulin Gunder Providence Oregon Standard Gold Plan - Choice Network

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: Tier six
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.

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 (28)

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 100 MG/ML Injection [Gamunex]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 [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 [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 [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 [Gamunex]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 [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 [Gammaked]Approval first
50 ML immunoglobulin G, human 100 MG/ML Injection [Gamunex]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
6 ML immune globulin subcutaneous (human) - hipp 165 MG/ML Injection [Cutaquig]Approval first

← All coverage for immunoglobulin G