Drug IndexEylea (Aflibercept)



Billing

Code: J0178

Description: Aflibercept injection

Unit: 1 MG

Payment: $821.980

Pay quarter: Q4 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:

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Billable NDCs

61755-0005-01

EYLEA (Regeneron Pharmaceuticals, Inc.)

1 SYRINGE, GLASS in 1 CARTON (61755-005-01) / .05 mL in 1 SYRINGE, GLASS


61755-0005-02

EYLEA (Regeneron Pharmaceuticals, Inc.)

1 VIAL, SINGLE-USE in 1 CARTON (61755-005-02) / .05 mL in 1 VIAL, SINGLE-USE


61755-0005-54

EYLEA (Regeneron Pharmaceuticals, Inc.)

1 SYRINGE, GLASS in 1 CARTON (61755-005-54) / .05 mL in 1 SYRINGE, GLASS


61755-0005-55

EYLEA (Regeneron Pharmaceuticals, Inc.)

1 VIAL, SINGLE-USE in 1 CARTON (61755-005-55) / .05 mL in 1 VIAL, SINGLE-USE



Prior Authorization


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