Drug IndexProvenge (Sipuleucel-T)



Billing

Code: Q2043

Description: Sipuleucel-t auto cd54+

Unit: 1 per

Payment: $55015.225

Pay quarter: Q4 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

N/A

Total Reimbursement:

N/A

(ASP: N/A, Margin: N/A)

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# Units to bill:

N/A

Billable NDCs

30237-8900-06

PROVENGE (Dendreon Pharmaceuticals LLC)

1 BAG in 1 CARTON (30237-8900-6) / 1 INJECTION in 1 BAG (30237-8900-5)



Prior Authorization


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