Bivigam - CuraFi

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Bivigam (IVIG)

Billing

Code: J1556

Description: Inj, imm glob bivigam, 500mg

Unit: 0.5 g

Payment: $72.962

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$4,377.72

(ASP: $4,129.92, Margin: $247.80)

Code:

J1556

# Units to bill:

Prior Authorization

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

1. Patients must be 18 years of age or older.
2. Patients must have a diagnosis of primary immunodeficiency disease (PIDD).
3. Patients must have tried and failed, been intolerant to, or not achieved an adequate response to conventional therapies for PIDD.
4. Patients must not have any contraindications to Bivigam infusion.
5. Patients must not be pregnant or lactating.
6. Patients must have a documented history of antibody deficiency.
7. Patients must have had a screening for hepatitis B and C, HIV, and syphilis.
8. Patients must not be receiving any other immunoglobulin therapy.
9. Patients must have a documented history of non-response or intolerance to other immunoglobulin therapies.
10. Patients must have laboratory values within normal ranges prior to initiation of therapy.

Insurance prior auth guidelines:

Billable NDCs

59730-6502-01

BIVIGAM (ADMA BIOLOGICS)

5000 MG

69800-6502-01

BIVIGAM (ADMA BIOLOGICS)

5000 MG