Prior authorization required

Does Aetna (CVS Health) require prior authorization for Gammagard?

Aetna (CVS Health) requires prior authorization for Gammagard on every Medicare Part D plan of theirs that covers it.

Every plan from this payer that covers the drug requires authorization before it is dispensed.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809667	22 / 658	22	Prior authorization required
50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809668	22 / 658	22	Prior authorization required
100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809670	22 / 658	22	Prior authorization required
immunoglobulin G, human 5000 MG Injection [Gammagard]1809730	22 / 658	22	Prior authorization required
immunoglobulin G, human 10000 MG Injection [Gammagard]1809738	22 / 658	22	Prior authorization required

Product names come from RxNorm (U.S. National Library of Medicine).

Plan-by-plan detail — 25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]

Gammagard has 5 products in the corpus; this table is for 25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard], the one carried on the most plans. The product table above covers every strength.

Plan	Contract	Tier	Prior auth	Step therapy	Qty limit
Community First Medicare Advantage Alamo Plan (HMO)	H5447-001	5	Yes	No	No
Community First Medicare Advantage D-SNP (HMO D-SNP)	H5447-002	5	Yes	No	No
El Paso Health Giveback (HMO)	H3407-003	5	Yes	No	No
El Paso Health Medicare Advantage Dual (HMO D-SNP)	H3407-001	5	Yes	No	No
El Paso Health Total (HMO)	H3407-002	5	Yes	No	No
Health First Classic H1099-001 (HMO-POS)	H1099-001	5	Yes	No	No
Health First Complete Care H1099-023 (HMO)	H1099-023	5	Yes	No	No
Health First Emerald Plus H1099-024 (HMO)	H1099-024	5	Yes	No	No
Health First Emerald Plus H1099-026 (HMO)	H1099-026	5	Yes	No	No
Health First Emerald Plus H1099-028 (HMO)	H1099-028	5	Yes	No	No
Health First Premier Access H1099-025 (HMO-POS)	H1099-025	5	Yes	No	No
Health First Premier Access H1099-027 (HMO-POS)	H1099-027	5	Yes	No	No
Health First Rewards H1099-014 (HMO)	H1099-014	5	Yes	No	No
Health First SunSaver H1099-016 (HMO)	H1099-016	5	Yes	No	No
Health First Value H1099-006 (HMO)	H1099-006	5	Yes	No	No
Healthfirst 65 Plus Plan (HMO)	H3359-001	5	Yes	No	No
Healthfirst CompleteCare (HMO D-SNP)	H3359-034	1	Yes	No	No
Healthfirst Connection Plan (HMO D-SNP)	H3359-038	5	Yes	No	No
Healthfirst Increased Benefits Plan (HMO)	H3359-019	5	Yes	No	No
Healthfirst Life Improvement Plan (HMO D-SNP)	H3359-021	5	Yes	No	No
Healthfirst Signature (HMO)	H1722-002	5	Yes	No	No
Healthfirst Signature (HMO)	H5989-011	5	Yes	No	No

Source

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File

Effective: 2026-06-30
Retrieved: 2026-07-19
SHA-256: e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae

We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.

Gammagard at other payers

Or see Gammagard across every payer at once.

Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.