Drug IndexPulmozyme (dornase alfa)



Billing

Code: J7639

Description: Dornase alfa non-comp unit

Unit: 1 MG

Payment: $52.077

Pay quarter: Q1 2024


Covered in Part D: Yes

Avg tier level: 4


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$126.10

Total Reimbursement:

$130.19

(ASP: $122.82, Margin: $7.37)

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# Units to bill:

3

Dosage & Frequency

Cystic Fibrosis (CF)

• 2.5mg once daily


Billable NDCs

50242-0100-40

Pulmozyme (GENENTECH, INC.)

75 MG



Prior Authorization


Resources

Website