Drug IndexBivigam (Immune Globulin Intravenous (Human))



Billing

Code: J1556

Description: Inj, imm glob bivigam, 500mg

Unit: 500 MG

Payment: $72.965

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:

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

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# Units to bill:

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Billable NDCs

69800-6502-01

BIVIGAM (ADMA Biologics, Inc.)

1 VIAL, SINGLE-USE in 1 CARTON (69800-6502-1) / 50 mL in 1 VIAL, SINGLE-USE (69800-6502-2)


69800-6503-01

BIVIGAM (ADMA Biologics, Inc.)

1 VIAL, SINGLE-USE in 1 CARTON (69800-6503-1) / 100 mL in 1 VIAL, SINGLE-USE (69800-6503-2)



Prior Authorization


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