Prior authorization required
Does Blue Cross Blue Shield (affiliate) require prior authorization for Gammagard?
Blue Cross Blue Shield (affiliate) 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 | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809667 | 170 / 269 | 170 | 0 | 0 | Prior authorization required |
| 50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809668 | 170 / 269 | 170 | 0 | 0 | Prior authorization required |
| 100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809670 | 170 / 269 | 170 | 0 | 0 | Prior authorization required |
| immunoglobulin G, human 5000 MG Injection [Gammagard]1809730 | 130 / 269 | 130 | 0 | 0 | Prior authorization required |
| immunoglobulin G, human 10000 MG Injection [Gammagard]1809738 | 130 / 269 | 130 | 0 | 0 | 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 |
|---|---|---|---|---|---|
| Blue Advantage Choice (PPO) | H0104-016 | 5 | Yes | No | No |
| Blue Advantage Complete (PPO) | H0104-012 | 5 | Yes | No | No |
| Blue Advantage Complete (PPO) | H0104-014 | 5 | Yes | No | No |
| Blue Advantage Premier (PPO) | H0104-015 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-009 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Choice (PPO) | H5959-014 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-015 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Comfort (PPO) | H5959-016 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-010 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Complete (PPO) | H5959-011 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-012 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Core (PPO) | H5959-013 | 5 | Yes | No | No |
| Blue Cross Medicare Advantage Secure (HMO) | H8547-001 | 5 | Yes | No | No |
| Blue Medicare Advantage Classic PPO (PPO) | H5900-008 | 5 | Yes | No | No |
| Blue Medicare Advantage Enhanced PPO (PPO) | H5900-004 | 5 | Yes | No | No |
| Blue Medicare Advantage PPO (PPO) | H5900-001 | 5 | Yes | No | No |
| Blue Medicare Choice (HMO) | H3449-026 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Enhanced (HMO-POS) | H3449-024 | 5 | Yes | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 5 | Yes | No | No |
| Blue Medicare Essential (HMO) | H3449-027 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare Essential Plus (HMO-POS) | H3449-023 | 5 | Yes | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 5 | Yes | No | No |
| Blue Medicare PPO Enhanced (PPO) | H3404-003 | 5 | Yes | No | No |
| Blue Medicare Rx Enhanced (PDP) | S5540-004 | 5 | Yes | No | No |
| Blue MedicareRx Plus (PDP) | S5726-014 | 5 | Yes | No | No |
| BlueCHiP for Medicare Access (HMO-POS) | H4152-022 | 5 | Yes | No | No |
| BlueCHiP for Medicare Enhanced (HMO-POS) | H4152-013 | 5 | Yes | No | No |
| BlueCHiP for Medicare Essential (HMO-POS) | H4152-023 | 5 | Yes | No | No |
| BlueCHiP for Medicare Extra (HMO-POS) | H4152-018 | 5 | Yes | No | No |
| BlueRI for Duals (HMO D-SNP) | H4152-021 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 5 | Yes | No | No |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | No |
| Community Blue Medicare HMO Merit (HMO) | H3384-071 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | No |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | No |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-039 | 5 | Yes | No | No |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-063 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | No |
| Community Blue Medicare PPO Signature (PPO) | H3916-065 | 5 | Yes | No | No |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | No |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | No |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | No |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | No |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | No |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | No |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | No |
| Complete Blue Plus PPO Merit (PPO) | H3916-064 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H3916-062 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H5106-029 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H5106-036 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H8166-006 | 5 | Yes | No | No |
| Complete Blue PPO Distinct (PPO) | H8166-007 | 5 | Yes | No | No |
Showing 100 of 170 covering plans.
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
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.