OCTAGAM IMMUNE GLOBULIN (HUMAN) 50 mg/mL Solution
Also known as Immune Globulin. Coverage in U.S. Virgin Islands (CMS PDP Region 39).
1 of 1 stand-alone Part D plans in U.S. Virgin Islands cover this drug on tier 5.
1 of 1 plans apply a prior authorization, step therapy or quantity limit.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$114.80/mo premium · $615.00 deductible | 5Specialty Tier | 25% | 25% | $10.8564 | — |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.