Drug IndexGamunex-C (IVIG)
Billing
Code: J1561
Description: Gamunex-c/gammaked
Unit: 500 mg
Payment: $49.786
Pay quarter: Q1 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$4,107.60Total Reimbursement:
$2,987.16(ASP: $2,818.08, Margin: $169.08)
.
.# Units to bill:
60Dosage & Frequency
Billable NDCs
13533-0800-12
Gamunex-C (GRIFOLS USA, LLC)
1000 MG
13533-0800-15
Gamunex-C (GRIFOLS USA, LLC)
2500 MG
13533-0800-20
Gamunex-C (GRIFOLS USA, LLC)
5000 MG
13533-0800-24
Gamunex-C (GRIFOLS USA, LLC)
20000 MG
13533-0800-40
Gamunex-C (GRIFOLS USA, LLC)
40000 MG
13533-0800-71
Gamunex-C (GRIFOLS USA, LLC)
10000 MG
76125-0900-10
GAMMAKED (KEDRION BIOPHARMA, INC.)
10000 MG
76125-0900-20
GAMMAKED (KEDRION BIOPHARMA, INC.)
20000 MG
76125-0900-50
GAMMAKED (KEDRION BIOPHARMA, INC.)
5000 MG
Prior Authorization
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