Drug IndexMonoferric (Ferric Derisomaltose)



Billing

Code: J1437

Description: Inj. fe derisomaltose 10 mg

Unit: 10 MG

Payment: $21.052

Pay quarter: Q4 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

N/A

Total Reimbursement:

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

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# Units to bill:

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Billable NDCs

73594-9301-02

Monoferric (Pharmacosmos Therapeutics Inc.)

5 VIAL in 1 BOX (73594-9301-2) / 1 mL in 1 VIAL (73594-9301-3)


73594-9305-01

Monoferric (Pharmacosmos Therapeutics Inc.)

1 VIAL in 1 BOX (73594-9305-1) / 5 mL in 1 VIAL


73594-9310-01

Monoferric (Pharmacosmos Therapeutics Inc.)

1 VIAL in 1 BOX (73594-9310-1) / 10 mL in 1 VIAL



Prior Authorization


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