Drug IndexXolair (Omalizumab)
Billing
Code: J2357
Description: Omalizumab injection
Unit: 5 MG
Payment: $38.326
Pay quarter: Q3 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
N/ATotal Reimbursement:
N/A(ASP: N/A, Margin: N/A)
.
.# Units to bill:
N/ABillable NDCs
50242-0040-62
XOLAIR (Genentech, Inc.)
1 VIAL, SINGLE-USE in 1 CARTON (50242-040-62) / 1.2 mL in 1 VIAL, SINGLE-USE
50242-0040-86
XOLAIR (Genentech, Inc.)
1 VIAL, SINGLE-USE in 1 CARTON (50242-040-86) / 1.2 mL in 1 VIAL, SINGLE-USE
50242-0214-01
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-01) / .5 mL in 1 SYRINGE, GLASS
50242-0214-03
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-03) / .5 mL in 1 SYRINGE, GLASS
50242-0214-55
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-55) / .5 mL in 1 SYRINGE, GLASS
50242-0214-83
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-83) / .5 mL in 1 SYRINGE, GLASS
50242-0214-86
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-86) / .5 mL in 1 SYRINGE, GLASS
50242-0214-99
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-214-99) / .5 mL in 1 SYRINGE, GLASS
50242-0215-01
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-01) / 1 mL in 1 SYRINGE, GLASS
50242-0215-03
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-03) / 1 mL in 1 SYRINGE, GLASS
50242-0215-55
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-55) / 1 mL in 1 SYRINGE, GLASS
50242-0215-83
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-83) / 1 mL in 1 SYRINGE, GLASS
50242-0215-86
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-86) / 1 mL in 1 SYRINGE, GLASS
50242-0215-99
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-215-99) / 1 mL in 1 SYRINGE, GLASS
50242-0227-01
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-227-01) / 2 mL in 1 SYRINGE, GLASS
50242-0227-55
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-227-55) / 2 mL in 1 SYRINGE, GLASS
50242-0227-86
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-227-86) / 2 mL in 1 SYRINGE, GLASS
50242-0227-99
XOLAIR (Genentech, Inc.)
1 SYRINGE, GLASS in 1 CARTON (50242-227-99) / 2 mL in 1 SYRINGE, GLASS
Prior Authorization
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