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:
$2,868.12Total Reimbursement:
$5,125.50(ASP: $4,835.38, Margin: $290.12)
.
.# Units to bill:
300Dosage & 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
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