Drug IndexPanzyga (Immune Globulin Intravenous, Human-Ifas)



Billing

Code: J1576

Description: Inj, panzyga, 500 mg

Unit: 500 MG

Payment: $69.765

Pay quarter: Q3 2024


Covered in Part D: Yes

Avg tier level: 4


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

00069-1011-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1011-02) / 10 mL in 1 BOTTLE, GLASS (0069-1011-01)


00069-1109-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1109-02) / 25 mL in 1 BOTTLE, GLASS (0069-1109-01)


00069-1224-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1224-02) / 50 mL in 1 BOTTLE, GLASS (0069-1224-01)


00069-1312-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1312-02) / 100 mL in 1 BOTTLE, GLASS (0069-1312-01)


00069-1415-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1415-02) / 200 mL in 1 BOTTLE, GLASS (0069-1415-01)


00069-1558-02

PANZYGA (Pfizer Laboratories Div Pfizer Inc)

1 BOTTLE, GLASS in 1 CARTON (0069-1558-02) / 300 mL in 1 BOTTLE, GLASS (0069-1558-01)


68982-0822-01

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-01) / 10 mL in 1 BOTTLE, GLASS (68982-822-81)


68982-0822-02

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-02) / 25 mL in 1 BOTTLE, GLASS (68982-822-82)


68982-0822-03

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-03) / 50 mL in 1 BOTTLE, GLASS (68982-822-83)


68982-0822-04

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-04) / 100 mL in 1 BOTTLE, GLASS (68982-822-84)


68982-0822-05

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-05) / 200 mL in 1 BOTTLE, GLASS (68982-822-85)


68982-0822-06

PANZYGA (Octapharma USA Inc)

1 BOTTLE, GLASS in 1 CARTON (68982-822-06) / 300 mL in 1 BOTTLE, GLASS (68982-822-86)



Prior Authorization


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