Drug IndexHyQvia (SCIG)



Billing

Code: J1575

Description: Hyqvia 100mg immuneglobulin

Unit: 100 mg

Payment: $17.085

Pay quarter: Q1 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$2,868.12

Total Reimbursement:

$5,125.50

(ASP: $4,835.38, Margin: $290.12)

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# Units to bill:

300

Dosage & Frequency


Billable NDCs

00944-2510-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

2500 MG


00944-2511-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

5000 MG


00944-2512-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

10000 MG


00944-2513-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

20000 MG


00944-2514-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

30000 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

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