Drug IndexByooviz (ranibizumab-nuna)



Billing

Code: Q5124

Description: Inj. byooviz, 0.1 mg

Unit: 0.1 MG

Payment: $175.058

Pay quarter: Q2 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$1,130.00

Total Reimbursement:

$875.29

(ASP: $825.75, Margin: $49.54)

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# Units to bill:

5

Dosage & Frequency

Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Macular Edema Following Retinal Vein Occlusion(RVO)

• 0.5mg IVT every 1 month

Myopic Choroidal Neovascularization (mCNV)

• 0.5mg IVT every 1 month for up to 3 months


Billable NDCs

64406-0019-01

Byooviz (Biogen)

0.5 mg



Prior Authorization

Aetna

Anthem

Cigna


Resources

Website