Drug IndexLeqembi (Lecanemab)



Billing

Code: J0174

Description: Inj, lecanemab-irmb, 1 mg

Unit: 1 MG

Payment: $1.339

Pay quarter: Q2 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

N/A

Total Reimbursement:

N/A

(ASP: N/A, Margin: N/A)

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# Units to bill:

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Billable NDCs

62856-0212-01

LEQEMBI (Eisai Inc.)

1 VIAL, SINGLE-DOSE in 1 CARTON (62856-212-01) / 2 mL in 1 VIAL, SINGLE-DOSE


62856-0215-01

LEQEMBI (Eisai Inc.)

1 VIAL, SINGLE-DOSE in 1 CARTON (62856-215-01) / 5 mL in 1 VIAL, SINGLE-DOSE



Prior Authorization


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