IMMUNE GLOBULINS

Displaying 1 - 50 of 56 records found.

Items in this class
Brand Name/Generic Name	NDC code	Clinical Prior Auth Required	PDL Prior Auth Required
BIVIGAM LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	59730650201	No	Yes
CUVITRU 1 GRAM/5 ML VIAL immun glob G(IgG)/gly/IgA ov50	00944285001	No	Yes
CUVITRU 10 GRAM/50 ML VIAL immun glob G(IgG)/gly/IgA ov50	00944285009	No	Yes
CUVITRU 2 GRAM/10 ML VIAL immun glob G(IgG)/gly/IgA ov50	00944285003	No	Yes
CUVITRU 4 GRAM/20 ML VIAL immun glob G(IgG)/gly/IgA ov50	00944285005	No	Yes
CUVITRU 8 GRAM/ 40 ML VIAL immun glob G(IgG)/gly/IgA ov50	00944285007	No	Yes
CYTOGAM 2.5 GM/50 ML VIAL cytomegalovirus immune globuln	44206053211	No	No
FLEBOGAMMA DIF 10% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000501	No	Yes
FLEBOGAMMA DIF 10% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000502	No	Yes
FLEBOGAMMA DIF 10% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000503	No	Yes
FLEBOGAMMA DIF 5% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000401	No	Yes
FLEBOGAMMA DIF 5% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000402	No	Yes
FLEBOGAMMA DIF 5% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000403	No	Yes
FLEBOGAMMA DIF 5% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000404	No	Yes
FLEBOGAMMA DIF 5% VIAL imm glob G (IgG)/sorb/IgA 0-50	61953000405	No	Yes
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270002	No	No
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270003	No	No
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270004	No	No
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270005	No	No
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270006	No	No
GAMMAGARD LIQUID 10% VIAL immun glob G(IgG)/gly/IgA ov50	00944270007	No	No
GAMMAKED 1 GRAM/10 ML VIAL immune globul G/gly/IgA avg 46	76125090001	No	No
GAMMAKED 10 GRAM/100 ML VIAL immune globul G/gly/IgA avg 46	76125090010	No	No
GAMMAKED 20 GRAM/200 ML VIAL immune globul G/gly/IgA avg 46	76125090020	No	No
GAMMAKED 5 GRAM/50 ML VIAL immune globul G/gly/IgA avg 46	76125090050	No	No
GAMUNEX-C 1 GRAM/10 ML VIAL immune globul G/gly/IgA avg 46	13533080012	No	No
GAMUNEX-C 10 GRAM/100 ML VIAL immune globul G/gly/IgA avg 46	13533080071	No	No
GAMUNEX-C 2.5 GRAM/25 ML VIAL immune globul G/gly/IgA avg 46	13533080015	No	No
GAMUNEX-C 20 GRAM/200 ML VIAL immune globul G/gly/IgA avg 46	13533080024	No	No
GAMUNEX-C 40 GRAM/400 ML VIAL immune globul G/gly/IgA avg 46	13533080040	No	No
GAMUNEX-C 5 GRAM/50 ML VIAL immune globul G/gly/IgA avg 46	13533080020	No	No
HIZENTRA 1 GRAM/5 ML VIAL immun glob G(IgG)/pro/IgA 0-50	44206045101	No	No
HIZENTRA 10 GRAM/50 ML VIAL immun glob G(IgG)/pro/IgA 0-50	44206045510	No	No
HIZENTRA 2 GRAM/10 ML VIAL immun glob G(IgG)/pro/IgA 0-50	44206045202	No	No
HIZENTRA 4 GRAM/20 ML VIAL immun glob G(IgG)/pro/IgA 0-50	44206045404	No	No
HYQVIA 10 GM-800 UNIT PACK IgG/hyaluronidase,recombinant	00944251202	No	Yes
HYQVIA 2.5 GM-200 UNIT PACK IgG/hyaluronidase,recombinant	00944251002	No	Yes
HYQVIA 20 GM-1,600 UNIT PACK IgG/hyaluronidase,recombinant	00944251302	No	Yes
HYQVIA 30 GM-2,400 UNIT PACK IgG/hyaluronidase,recombinant	00944251402	No	Yes
HYQVIA 5 GM-400 UNIT PACK IgG/hyaluronidase,recombinant	00944251102	No	Yes
OCTAGAM 10% VIAL immun globG(IgG)/malt/IgA ov50	68982085001	No	Yes
OCTAGAM 10% VIAL immun globG(IgG)/malt/IgA ov50	68982085002	No	Yes
OCTAGAM 10% VIAL immun globG(IgG)/malt/IgA ov50	68982085003	No	Yes
OCTAGAM 10% VIAL immun globG(IgG)/malt/IgA ov50	68982085004	No	Yes
OCTAGAM 5% VIAL immun globG(IgG)/malt/IgA ov50	68982084001	No	Yes
OCTAGAM 5% VIAL immun globG(IgG)/malt/IgA ov50	68982084002	No	Yes
OCTAGAM 5% VIAL immun globG(IgG)/malt/IgA ov50	68982084003	No	Yes
OCTAGAM 5% VIAL immun globG(IgG)/malt/IgA ov50	68982084004	No	Yes
PRIVIGEN 10% VIAL immun glob G(IgG)/pro/IgA 0-50	44206043605	No	Yes
PRIVIGEN 10% VIAL immun glob G(IgG)/pro/IgA 0-50	44206043710	No	Yes

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