Drug IndexXolair (Omalizumab)



Billing

Code: J2357

Description: Omalizumab injection

Unit: 5 MG

Payment: $36.806

Pay quarter: Q2 2024


Covered in Part D: Yes

Avg tier level: 4


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

N/A

Total Reimbursement:

N/A

(ASP: N/A, Margin: N/A)

.

.

# Units to bill:

N/A

Billable 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


Resources