GAMMAKED 10 g/100mL Injection
Also known as Immune Globulin (Human). Coverage in Pennsylvania and West Virginia (CMS PDP Region 06).
1 of 12 stand-alone Part D plans in Pennsylvania and West Virginia cover this drug on tier 5.
1 of 1 plans apply a prior authorization, step therapy or quantity limit.
135 Medicare Advantage plans in PA, WV do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. PA: 127 plans · WV: 8 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$22.70/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $23.3522 | — |
|
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.