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:

N/A

Total Reimbursement:

N/A

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

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# Units to bill:

N/A

Billable NDCs

64406-0019-01

Byooviz (Biogen Inc.)

1 VIAL, SINGLE-DOSE in 1 CARTON (64406-019-01) / .05 mL in 1 VIAL, SINGLE-DOSE (64406-019-07)


64406-0019-08

Byooviz (Biogen Inc.)

1 VIAL, SINGLE-DOSE in 1 CARTON (64406-019-08) / .05 mL in 1 VIAL, SINGLE-DOSE (64406-019-09)



Prior Authorization


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