Drug IndexBenlysta (Belimumab)


Billing

Code: J0490

Description: Belimumab injection

Unit: 10 MG

Payment: $54.149

Pay quarter: Q4 2024

Covered in Part D: Yes

Avg tier level: 4

Drug Cost

Calculate drug cost and reimbursement


Total WAC:

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Total Reimbursement:

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(ASP: N/A, Margin: N/A)

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# Units to bill:

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Billable NDCs

49401-0088-02

BENLYSTA (GlaxoSmithKline LLC)

1 SYRINGE in 1 CARTON (49401-088-02) / 1 mL in 1 SYRINGE (49401-088-01)


49401-0088-35

BENLYSTA (GlaxoSmithKline LLC)

4 SYRINGE in 1 CARTON (49401-088-35) / 1 mL in 1 SYRINGE (49401-088-01)


49401-0088-47

BENLYSTA (GlaxoSmithKline LLC)

4 SYRINGE in 1 CARTON (49401-088-47) / 1 mL in 1 SYRINGE (49401-088-42)


49401-0088-50

BENLYSTA (GlaxoSmithKline LLC)

1 SYRINGE in 1 CARTON (49401-088-50) / 1 mL in 1 SYRINGE (49401-088-42)


49401-0088-61

BENLYSTA (GlaxoSmithKline LLC)

1 SYRINGE in 1 CARTON (49401-088-61) / 1 mL in 1 SYRINGE


49401-0101-01

BENLYSTA (GlaxoSmithKline LLC)

1 VIAL in 1 CARTON (49401-101-01) / 1.5 mL in 1 VIAL


49401-0102-01

BENLYSTA (GlaxoSmithKline LLC)

1 VIAL in 1 CARTON (49401-102-01) / 5 mL in 1 VIAL


Prior Authorization

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