Serums

Showing 1–12 of 58 results

NAME	ALSO KNOW AS	DRUG CATEGORY	FORMULARY CATEGORY	WHAT WE COVER	COST SHARE
Immune Globulin (Human)-Hipp Soln 2Gm/12Ml (Generic)	Cutaquig Soln 2 Gm/12Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hipp Soln 3.3Gm/20Ml (Generic)	Cutaquig Soln 3.3 Gm/20Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hipp Soln 4Gm/24Ml (Generic)	Cutaquig Soln 4 Gm/24Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hyaluronidase (Human Recombinant) Kit (Generic)	Hyqvia Kit 20 Gm/200Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hyaluronidase (Human Recombinant) Kit (Generic)	Hyqvia Kit 10 Gm/100Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hyaluronidase (Human Recombinant) Kit (Generic)	Hyqvia Kit 5 Gm/50Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hyaluronidase (Human Recombinant) Kit (Generic)	Hyqvia Kit 2.5 Gm/25Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Hyaluronidase (Human Recombinant) Kit (Generic)	Hyqvia Kit 30 Gm/300Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 10Gm/100Ml (Generic)	Panzyga Soln 10 Gm/100Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 1Gm/10Ml (Generic)	Panzyga Soln 1 Gm/10Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 2.5Gm/25Ml (Generic)	Panzyga Soln 2.5 Gm/25Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 20Gm/200Ml (Generic)	Panzyga Soln 20 Gm/200Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 30Gm/300Ml (Generic)	Panzyga Soln 30 Gm/300Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Ifas Soln 5Gm/50Ml (Generic)	Panzyga Soln 5 Gm/50Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Immune Globulin (Human)-Slra Soln 5Gm/50Ml (Generic)	Asceniv Soln 5 Gm/50Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Rabies Immune Globulin (Human) Soln 1500Unit/10Ml (Generic)	Hyperrab S/D Soln 1500 Unit/10Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Rabies Immune Globulin (Human) Soln 300Unit/2Ml (Generic)	Hyperrab S/D Soln 300 Unit/2Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Rabies Immune Globulin (Human) Soln 300Unit/2Ml (Generic)	Imogam Rabies-Ht Soln 300 Unit/2Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Varicella-Zoster Immune Globulin (Human) Soln 125Unit/1.2Ml (Generic)	Varizig Soln 125 Unit/1.2Ml (Brand)	Serums	MA	Administered in Medical Office	N/A
Xembify Soln 1 Gm/5Ml (Brand)	Immune Globulin (Human)-Klhw Soln 1Gm/5Ml (Generic)	Serums	3	Non-Formulary Brand	$68
Xembify Soln 10 Gm/50Ml (Brand)	Immune Globulin (Human)-Klhw Soln 10Gm/50Ml (Generic)	Serums	3	Non-Formulary Brand	$68
Xembify Soln 2 Gm/10Ml (Brand)	Immune Globulin (Human)-Klhw Soln 2Gm/10Ml (Generic)	Serums	3	Non-Formulary Brand	$68
Xembify Soln 4 Gm/20Ml (Brand)	Immune Globulin (Human)-Klhw Soln 4Gm/20Ml (Generic)	Serums	3	Non-Formulary Brand	$68

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