Drug IndexHizentra (Immune Globulin Subcutaneous (Human))


Billing

Code: J1559

Description: Hizentra injection

Unit: 100 MG

Payment: $13.188

Pay quarter: Q3 2024

Covered in Part D: No

Drug Cost

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Total WAC:

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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

44206-0451-01

Hizentra (CSL Behring AG)

1 VIAL, SINGLE-DOSE in 1 CARTON (44206-451-01) / 5 mL in 1 VIAL, SINGLE-DOSE (44206-451-90)


44206-0452-02

Hizentra (CSL Behring AG)

1 VIAL, SINGLE-DOSE in 1 CARTON (44206-452-02) / 10 mL in 1 VIAL, SINGLE-DOSE (44206-452-91)


44206-0454-04

Hizentra (CSL Behring AG)

1 VIAL, SINGLE-DOSE in 1 CARTON (44206-454-04) / 20 mL in 1 VIAL, SINGLE-DOSE (44206-454-92)


44206-0455-10

Hizentra (CSL Behring AG)

1 VIAL, SINGLE-DOSE in 1 CARTON (44206-455-10) / 50 mL in 1 VIAL, SINGLE-DOSE (44206-455-93)


44206-0455-25

Hizentra (CSL Behring AG)

1 SYRINGE in 1 CARTON (44206-455-25) / 50 mL in 1 SYRINGE (44206-455-97)


44206-0456-21

Hizentra (CSL Behring AG)

1 SYRINGE in 1 CARTON (44206-456-21) / 5 mL in 1 SYRINGE (44206-456-94)


44206-0457-22

Hizentra (CSL Behring AG)

1 SYRINGE in 1 CARTON (44206-457-22) / 10 mL in 1 SYRINGE (44206-457-95)


44206-0458-24

Hizentra (CSL Behring AG)

1 SYRINGE in 1 CARTON (44206-458-24) / 20 mL in 1 SYRINGE (44206-458-96)


Prior Authorization

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