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:
$126.10Total Reimbursement:
$130.19(ASP: $122.82, Margin: $7.37)
.
.# Units to bill:
3Dosage & Frequency
Cystic Fibrosis (CF)
• 2.5mg once daily
• 2.5mg once daily
Billable NDCs
50242-0100-40
Pulmozyme (GENENTECH, INC.)
75 MG
Prior Authorization
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