Drug IndexHizentra (Immune Globulin Subcutaneous (Human))
Billing
Code: J1559
Description: Hizentra injection
Unit: 100 MG
Payment: $13.232
Pay quarter: Q4 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
N/ATotal Reimbursement:
N/A(ASP: N/A, Margin: N/A)
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.# Units to bill:
N/ABillable NDCs
44206-0451-01
Hizentra (CSL Behring AG)
1 VIAL, SINGLE-DOSE in 1 CARTON (44206-451-01) / 5 mL in 1 VIAL, SINGLE-DOSE (44206-451-90)
44206-0452-02
Hizentra (CSL Behring AG)
1 VIAL, SINGLE-DOSE in 1 CARTON (44206-452-02) / 10 mL in 1 VIAL, SINGLE-DOSE (44206-452-91)
44206-0454-04
Hizentra (CSL Behring AG)
1 VIAL, SINGLE-DOSE in 1 CARTON (44206-454-04) / 20 mL in 1 VIAL, SINGLE-DOSE (44206-454-92)
44206-0455-10
Hizentra (CSL Behring AG)
1 VIAL, SINGLE-DOSE in 1 CARTON (44206-455-10) / 50 mL in 1 VIAL, SINGLE-DOSE (44206-455-93)
44206-0455-25
Hizentra (CSL Behring AG)
1 SYRINGE in 1 CARTON (44206-455-25) / 50 mL in 1 SYRINGE (44206-455-97)
44206-0456-21
Hizentra (CSL Behring AG)
1 SYRINGE in 1 CARTON (44206-456-21) / 5 mL in 1 SYRINGE (44206-456-94)
44206-0457-22
Hizentra (CSL Behring AG)
1 SYRINGE in 1 CARTON (44206-457-22) / 10 mL in 1 SYRINGE (44206-457-95)
44206-0458-24
Hizentra (CSL Behring AG)
1 SYRINGE in 1 CARTON (44206-458-24) / 20 mL in 1 SYRINGE (44206-458-96)
Prior Authorization
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