Drug IndexProvenge (Sipuleucel-T)



Billing

Code: Q2043

Description: Sipuleucel-t auto cd54+

Unit: 1 per

Payment: $55453.567

Pay quarter: Q2 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$70,816.00

Total Reimbursement:

$55,453.57

(ASP: $52,314.69, Margin: $3,138.88)

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# Units to bill:

1

Dosage & Frequency

Prostate cancer

• One dose IV every 2 weeks for 3 doses


Billable NDCs

30237-8900-06

PROVENGE (DENDREON PHARMACEUTICALS LLC)

0 Per infusion (minimum 50 million cells)



Prior Authorization

Aetna

Anthem


Resources

Website