Drug IndexCimzia (Certolizumab Pegol)
Billing
Code: J0717
Description: Certolizumab pegol inj 1mg
Unit: 1 MG
Payment: $4.652
Pay quarter: Q4 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
N/ATotal Reimbursement:
N/A(ASP: N/A, Margin: N/A)
.
.# Units to bill:
N/ABillable NDCs
50474-0700-61
Cimzia (UCB, Inc.)
2 KIT in 1 CARTON (50474-700-61) / 1 KIT in 1 KIT * 1 mL in 1 VIAL, GLASS * 1 mL in 1 VIAL, GLASS
50474-0700-62
Cimzia (UCB, Inc.)
2 KIT in 1 CARTON (50474-700-62) / 1 KIT in 1 KIT * 1 mL in 1 VIAL, GLASS * 1 mL in 1 VIAL, GLASS
50474-0710-79
Cimzia (UCB, Inc.)
2 SYRINGE, GLASS in 1 CARTON (50474-710-79) / 1 mL in 1 SYRINGE, GLASS
50474-0710-80
Cimzia (UCB, Inc.)
2 SYRINGE, GLASS in 1 CARTON (50474-710-80) / 1 mL in 1 SYRINGE, GLASS
50474-0710-81
Cimzia (UCB, Inc.)
3 CARTON in 1 BOX (50474-710-81) / 2 SYRINGE, GLASS in 1 CARTON / 1 mL in 1 SYRINGE, GLASS
Prior Authorization
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