Drug IndexPanzyga (IVIG)
Billing
Code: J1576
Description: Inj, panzyga, 500 mg
Unit: 500 MG
Payment: $64.949
Pay quarter: Q2 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$6,390.00Total Reimbursement:
$3,896.94(ASP: $3,676.36, Margin: $220.58)
.
.# Units to bill:
60Dosage & Frequency
Billable NDCs
00069-1109-02
PANZYGA (PFIZER INC.)
2500 MG
00069-1224-02
PANZYGA (PFIZER INC.)
5000 MG
00069-1312-02
PANZYGA (PFIZER INC.)
10000 MG
00069-1415-02
PANZYGA (PFIZER INC.)
20000 MG
00069-1558-02
PANZYGA (PFIZER INC.)
30000 MG
68982-0822-02
PANZYGA (OCTAPHARMA)
2500 MG
68982-0822-03
PANZYGA (OCTAPHARMA)
5000 MG
68982-0822-04
PANZYGA (OCTAPHARMA)
10000 MG
68982-0822-05
PANZYGA (OCTAPHARMA)
20000 MG
68982-0822-06
PANZYGA (OCTAPHARMA)
30000 MG
Prior Authorization
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