RhoGAM
Generic: Rho(D) immune globulin, human
Prefilled Syringe
Also known as:
Rho(D) immune globulin, human
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Oscar Health
56 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Bronze Classic Standard
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic Standard
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Classic Standard
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic Standard | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic Standard | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Classic Standard | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Elite + PCP Saver Plus
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Secure
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic 4700
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple PCP Saver
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Elite Saver Plus
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Diabetes
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Secure | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Classic 4700 | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Classic | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Diabetes | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple PCP Saver | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Gold Elite Saver Plus | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Bronze Simple Diabetes | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Chronic Care CKM | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
AIAN Cost Share
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
|
AIAN Cost Share | with Atrium Health
via MICRhoGAM |
Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |