Drug IndexTrogarzo (ibalizumab-uiyk)
Billing
Code: J1746
Description: Inj., ibalizumab-uiyk, 10 mg
Unit: 10 MG
Payment: $74.645
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$5,726.00Total Reimbursement:
$5,971.60(ASP: $5,633.58, Margin: $338.02)
.
.# Units to bill:
80Dosage & Frequency
Human Immunodeficiency Virus Type 1 (HIV-1)
Loading dose:
• 2000mg IV
Maintenance:
• 800 mg every 2 weeks
Loading dose:
• 2000mg IV
Maintenance:
• 800 mg every 2 weeks
Billable NDCs
62064-0122-02
Trogarzo (THERATECHNOLOGIES INC.)
400 MG
Prior Authorization
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