Varies by plan

Does SCAN Health Plan require prior authorization for Gammagard?

Prior authorization for Gammagard differs across SCAN Health Plan's Medicare Part D plans and product strengths — 3 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	74 / 74	74	Prior authorization required
50 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809668	0 / 74	0	Not on formulary
100 ML immunoglobulin G, human 100 MG/ML Injection [Gammagard]1809670	0 / 74	0	Not on formulary
immunoglobulin G, human 5000 MG Injection [Gammagard]1809730	74 / 74	74	Prior authorization required
immunoglobulin G, human 10000 MG Injection [Gammagard]1809738	74 / 74	74	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
SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	H5425-092	5	Yes	No	No
SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	H5425-096	5	Yes	No	No
SCAN Affirm partnered with Included LGBTQ+ Health (HMO)	H5425-107	5	Yes	No	No
SCAN Allied (HMO)	H5425-118	5	Yes	No	No
SCAN Allied (HMO)	H5425-123	5	Yes	No	No
SCAN Alta (HMO)	H5425-082	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H0978-002	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H1822-002	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5244-002	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-034	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-070	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-076	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-102	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-104	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-105	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-106	5	Yes	No	No
SCAN Balance (HMO C-SNP)	H5425-129	5	Yes	No	No
SCAN Balance Texas (HMO C-SNP)	H8902-002	5	Yes	No	No
SCAN Classic (HMO)	H0978-001	5	Yes	No	No
SCAN Classic (HMO)	H1822-001	5	Yes	No	No
SCAN Classic (HMO)	H5244-001	5	Yes	No	No
SCAN Classic (HMO)	H5425-001	5	Yes	No	No
SCAN Classic (HMO)	H5425-005	5	Yes	No	No
SCAN Classic (HMO)	H5425-006	5	Yes	No	No
SCAN Classic (HMO)	H5425-007	5	Yes	No	No
SCAN Classic (HMO)	H5425-008	5	Yes	No	No
SCAN Classic (HMO)	H5425-009	5	Yes	No	No
SCAN Classic (HMO)	H5425-019	5	Yes	No	No
SCAN Classic (HMO)	H5425-069	5	Yes	No	No
SCAN Classic (HMO)	H5425-075	5	Yes	No	No
SCAN Classic (HMO)	H5425-101	5	Yes	No	No
SCAN Classic (HMO)	H5425-128	5	Yes	No	No
SCAN Classic Texas (HMO)	H8902-010	5	Yes	No	No
SCAN Classic WA (HMO)	H4026-001	5	Yes	No	No
SCAN Compass (HMO)	H5425-124	5	Yes	No	No
SCAN Connections (HMO D-SNP)	H0976-001	5	Yes	No	No
SCAN Connections at Home (HMO D-SNP)	H0976-002	5	Yes	No	No
SCAN Desert Choice (HMO)	H5425-135	5	Yes	No	No
SCAN Embrace (HMO I-SNP)	H5425-086	5	Yes	No	No
SCAN Embrace (HMO I-SNP)	H5425-087	5	Yes	No	No
SCAN Embrace (HMO-POS I-SNP)	H1822-005	5	Yes	No	No
SCAN Embrace (HMO-POS I-SNP)	H5425-091	5	Yes	No	No
SCAN Embrace Together (HMO I-SNP)	H5425-131	5	Yes	No	No
SCAN Embrace Together (HMO-POS I-SNP)	H1822-008	5	Yes	No	No
SCAN Embrace Together (HMO-POS I-SNP)	H5425-132	5	Yes	No	No
SCAN Essential Savings (HMO)	H5425-133	5	Yes	No	No
SCAN Inspired by women for women (HMO)	H5425-100	5	Yes	No	No
SCAN MyChoice (HMO)	H0978-011	5	Yes	No	No
SCAN MyChoice (HMO)	H1822-007	5	Yes	No	No
SCAN MyChoice (HMO)	H5244-005	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-108	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-109	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-110	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-119	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-120	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-121	5	Yes	No	No
SCAN MyChoice (HMO)	H5425-130	5	Yes	No	No
SCAN MyChoice Texas (HMO)	H8902-011	5	Yes	No	No
SCAN MyChoice WA (HMO)	H4026-002	5	Yes	No	No
SCAN Prime (HMO)	H5425-065	5	Yes	No	No
SCAN Select (HMO)	H5425-134	5	Yes	No	No
SCAN Strive (HMO C-SNP)	H0978-010	5	Yes	No	No
SCAN Strive (HMO C-SNP)	H1822-006	5	Yes	No	No
SCAN Strive (HMO C-SNP)	H5244-004	5	Yes	No	No
SCAN Strive (HMO C-SNP)	H5425-097	5	Yes	No	No
SCAN Strive (HMO C-SNP)	H5425-098	5	Yes	No	No
SCAN Strive Texas (HMO C-SNP)	H8902-009	5	Yes	No	No
SCAN Venture (HMO)	H5425-084	5	Yes	No	No
SCAN Venture (HMO)	H5425-085	5	Yes	No	No
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-125	5	Yes	No	No
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-126	5	Yes	No	No
Sutter Senior Advantage, a SCAN Medicare Plan (HMO)	H5425-127	5	Yes	No	No
VillageHealth (HMO-POS C-SNP)	H5943-003	5	Yes	No	No
VillageHealth (HMO-POS C-SNP)	H5943-004	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.