Drug IndexProlastin-C (A1-PI)
Billing
Code: J0256
Description: Alpha 1 proteinase inhibitor
Unit: 10 MG
Payment: $4.883
Pay quarter: Q1 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$2,688.00Total Reimbursement:
$2,343.84(ASP: $2,211.17, Margin: $132.67)
.
.# Units to bill:
480Dosage & Frequency
Alpha-1 Antitrypsin Deficiency
• 60mg/kg IV every 1 week
• 60mg/kg IV every 1 week
Billable NDCs
00053-7201-02
Zemaira (CSL BEHRING LLC)
1 MG
00944-2814-01
Aralast NP (TAKEDA PHARMACEUTICALS AMERICA, INC.)
1 MG
00944-2815-01
Aralast NP (TAKEDA PHARMACEUTICALS AMERICA, INC.)
1 MG
13533-0705-01
Prolastin-C (GRIFOLS USA, LLC)
1 MG
Prior Authorization
Resources