Varies by plan

Does Bravo Health Pennsylvania, INC. require prior authorization for Gammagard?

Prior authorization for Gammagard differs across Bravo Health Pennsylvania, INC.'s Medicare Part D plans and product strengths — 1 of 5 Gammagard products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.

Some plans require authorization and others do not. The member's specific plan decides.

This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm product	Plans covering	Require prior auth	Status
25 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809667	35 / 35	35	Prior authorization required
50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809668	0 / 35	0	Not on formulary
100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809670	0 / 35	0	Not on formulary
immunoglobulin G, human 5000 MG Injection [Gammagard]1809730	0 / 35	0	Not on formulary
immunoglobulin G, human 10000 MG Injection [Gammagard]1809738	0 / 35	0	Not on formulary

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
HealthSpring Achieve (HMO C-SNP)	H0354-027	5	Yes	No	No
HealthSpring Achieve (HMO C-SNP)	H3949-024	5	Yes	No	No
HealthSpring Alliance (HMO)	H0354-028	5	Yes	No	No
HealthSpring Preferred (HMO)	H0354-001	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-035	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-045	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-047	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-049	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-052	5	Yes	No	No
HealthSpring Preferred (HMO)	H3949-054	5	Yes	No	No
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	No
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	No
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	No
HealthSpring Preferred (HMO)	H9725-009	5	Yes	No	No
HealthSpring Preferred Full Savings (HMO)	H0354-030	5	Yes	No	No
HealthSpring Preferred PA (HMO)	H3949-031	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H3949-030	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H3949-048	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	No
HealthSpring Preferred Plus (HMO)	H9725-017	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H0354-029	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H3949-053	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9725-015	5	Yes	No	No
HealthSpring Preferred Savings (HMO)	H9725-016	5	Yes	No	No
HealthSpring Preferred Select (HMO)	H9725-014	5	Yes	No	No
HealthSpring Premier (HMO-POS)	H9725-018	5	Yes	No	No
HealthSpring TotalCare (HMO D-SNP)	H9725-003	5	Yes	No	No
HealthSpring TotalCare Plus (HMO D-SNP)	H2752-003	5	Yes	No	No
HealthSpring TotalCare Plus (HMO D-SNP)	H3949-009	5	Yes	No	No
HealthSpring TotalCare Plus (HMO D-SNP)	H9725-013	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.