Drug IndexMonoferric (ferric derisomaltose)
Billing
Code: J1437
Description: Inj. fe derisomaltose 10 mg
Unit: 10 MG
Payment: $19.936
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$3,246.77Total Reimbursement:
$1,993.60(ASP: $1,880.75, Margin: $112.85)
.
.# Units to bill:
100Dosage & Frequency
Iron Deficiency Anemia (IDA)
• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg
• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg
Billable NDCs
73594-9310-01
Monoferric (PHARMACOSMOS THERAPEUTICS)
1000 MG
Prior Authorization
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