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:

$3,072.00

Total Reimbursement:

$2,569.44

(ASP: $2,424.00, Margin: $145.44)

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# Units to bill:

480

Dosage & Frequency

Alpha-1 Antitrypsin Deficiency

• 60mg/kg IV every 1 week


Billable NDCs

00944-2884-01

GLASSIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

1 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

Website