Drug IndexBivigam (IVIG)



Billing

Code: J1556

Description: Inj, imm glob bivigam, 500mg

Unit: 500 mg

Payment: $72.962

Pay quarter: Q1 2024


Covered in Part D: Yes

Avg tier level: 4


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$4,255.20

Total Reimbursement:

$4,377.72

(ASP: $4,129.92, Margin: $247.80)

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# Units to bill:

60

Dosage & Frequency


Billable NDCs

69800-6502-01

BIVIGAM (ADMA BIOLOGICS)

5000 MG


69800-6503-01

BIVIGAM (ADMA BIOLOGICS)

10000 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

Website