Drug IndexOctagam (IVIG)
Billing
Code: J1568
Description: Octagam injection
Unit: 500 MG
Payment: $46.980
Pay quarter: Q2 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$5,388.00Total Reimbursement:
$2,818.80(ASP: $2,659.25, Margin: $159.55)
.
.# Units to bill:
60Dosage & Frequency
Billable NDCs
68982-0840-01
Octagam (OCTAPHARMA)
1000 MG
68982-0840-02
Octagam (OCTAPHARMA)
2500 MG
68982-0840-03
Octagam (OCTAPHARMA)
5000 MG
68982-0840-04
Octagam (OCTAPHARMA)
10000 MG
68982-0850-01
Octagam (OCTAPHARMA)
2000 MG
68982-0850-02
Octagam (OCTAPHARMA)
5000 MG
68982-0850-03
Octagam (OCTAPHARMA)
10000 MG
68982-0850-04
Octagam (OCTAPHARMA)
20000 MG
68982-0850-05
Octagam (OCTAPHARMA)
30000 MG
Prior Authorization
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