Drug IndexGlassia (A1-PI)
Billing
Code: J0257
Description: Glassia injection
Unit: 10 MG
Payment: $5.353
Pay quarter: Q1 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$3,072.00Total Reimbursement:
$2,569.44(ASP: $2,424.00, Margin: $145.44)
.
.# Units to bill:
480Dosage & Frequency
Alpha-1 Antitrypsin Deficiency
• 60mg/kg IV every 1 week
• 60mg/kg IV every 1 week
Billable NDCs
00944-2884-01
GLASSIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)
1 MG
Prior Authorization
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