Drug IndexCutaquig (SCIG)



Billing

Code: J1551

Description: Inj cutaquig 100 mg

Unit: 100 mg

Payment: $13.888

Pay quarter: Q1 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$6,155.40

Total Reimbursement:

$4,166.40

(ASP: $3,930.57, Margin: $235.83)

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# Units to bill:

300

Dosage & Frequency


Billable NDCs

00069-1061-02

Cutaquig (PFIZER INC.)

1000 MG


00069-1476-02

Cutaquig (PFIZER INC.)

2000 MG


00069-1509-02

Cutaquig (PFIZER INC.)

4000 MG


00069-1965-02

Cutaquig (PFIZER INC.)

8000 MG


68982-0810-01

Cutaquig (OCTAPHARMA)

1000 MG


68982-0810-03

Cutaquig (OCTAPHARMA)

2000 MG


68982-0810-04

Cutaquig (OCTAPHARMA)

3300 MG


68982-0810-05

Cutaquig (OCTAPHARMA)

4000 MG


68982-0810-06

Cutaquig (OCTAPHARMA)

8000 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

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