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Trogarzo (ibalizumab-uiyk)


Billing

Code: J1746

Description: Inj., ibalizumab-uiyk, 10 mg

Unit: 10 mg

Payment: $69.614

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Human Immunodeficiency Virus Type 1 (HIV-1)

Loading dose:
• 2000mg IV

Maintenance:
• 800 mg every 2 weeks

Calculate drug reimbursement


Total Reimbursement:

$5,903.27

(ASP: $5,569.12, Margin: $334.15)


Code:

J1746

# Units to bill:

80

Prior Authorization

Prior auth criteria for Trogarzo may include but is not limited to:





Insurance prior auth guidelines:


Billable NDCs

62064-0122-02

Trogarzo (THERATECHNOLOGIES INC.)

400 MG



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