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:

$4,107.60

Total Reimbursement:

$2,987.16

(ASP: $2,818.08, Margin: $169.08)

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# Units to bill:

60

Dosage & 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

Aetna

United Healthcare

Anthem

Cigna


Resources

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