Drug IndexFasenra (Benralizumab)



Billing

Code: J0517

Description: Inj., benralizumab, 1 mg

Unit: 1 MG

Payment: $168.222

Pay quarter: Q3 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

00310-1730-30

FASENRA (AstraZeneca Pharmaceuticals LP)

1 SYRINGE, GLASS in 1 CARTON (0310-1730-30) / 1 mL in 1 SYRINGE, GLASS


00310-1730-85

FASENRA (AstraZeneca Pharmaceuticals LP)

1 SYRINGE, GLASS in 1 CARTON (0310-1730-85) / 1 mL in 1 SYRINGE, GLASS


00310-1745-01

FASENRA (AstraZeneca Pharmaceuticals LP)

1 CARTRIDGE in 1 CARTON (0310-1745-01) / .5 mL in 1 CARTRIDGE


00310-1745-95

FASENRA (AstraZeneca Pharmaceuticals LP)

1 CARTRIDGE in 1 CARTON (0310-1745-95) / .5 mL in 1 CARTRIDGE


00310-1830-30

FASENRA (AstraZeneca Pharmaceuticals LP)

1 CARTRIDGE in 1 CARTON (0310-1830-30) / 1 mL in 1 CARTRIDGE


00310-1830-85

FASENRA (AstraZeneca Pharmaceuticals LP)

1 CARTRIDGE in 1 CARTON (0310-1830-85) / 1 mL in 1 CARTRIDGE



Prior Authorization


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