Drug IndexInflectra (infliximab-dyyb)
Billing
Code: Q5103
Description: Injection, inflectra
Unit: 10 MG
Payment: $11.092
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$2,838.84Total Reimbursement:
$332.76(ASP: $313.92, Margin: $18.84)
.
.# Units to bill:
30Dosage & Frequency
Crohn's Disease (CD)
Ulcerative Colitis (UC)
Ankylosing Spondylitis (AS)
Psoriatic Arthritis (PsA)
Plaque Psoriasis (Ps)
Induction:
• 5mg/kg IV at 0, 2, and 6 weeks
Maintenance:
• 5mg/kg IV every 8 weeks
Ulcerative Colitis (UC)
Ankylosing Spondylitis (AS)
Psoriatic Arthritis (PsA)
Plaque Psoriasis (Ps)
Induction:
• 5mg/kg IV at 0, 2, and 6 weeks
Maintenance:
• 5mg/kg IV every 8 weeks
Rheumatoid Arthritis (RA)
Induction:
• 3mg/kg IV at 0, 2, and 6 weeks
Maintenance:
• 3mg/kg IV every 8 weeks
Induction:
• 3mg/kg IV at 0, 2, and 6 weeks
Maintenance:
• 3mg/kg IV every 8 weeks
Billable NDCs
00069-0809-01
Inflectra (PFIZER INC.)
100 MG
Prior Authorization
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