HyQvia - CuraFi

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HyQvia (SCIG)

Billing

Code: J1575

Description: Hyqvia 100mg immuneglobulin

Unit: 0.1 g

Payment: $16.888

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$5,066.40

(ASP: $4,779.62, Margin: $286.78)

Code:

J1575

# Units to bill:

300

Prior Authorization

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

1. The patient must have a primary immunodeficiency disorder (PIDD) that is documented in the medical record by a qualified health care provider.

2. The patient must be at least 12 years old and have a body weight of at least 20 kg.

3. The patient must not have any active infection at the time of therapy.

4. The patient must not have any contraindications to the use of Hyqvia.

5. The patient must have a confirmed diagnosis of PIDD, based on laboratory testing results.

6. The patient's diagnosis of PIDD must be verified by a qualified health care provider.

7. The patient must have failed one or more other forms of immunoglobulin replacement therapy.

8. The patient must be willing and able to comply with the recommended treatment regimen.

Insurance prior auth guidelines:

Billable NDCs

00944-2510-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

2500 MG

00944-2511-02

HYQVIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)

5000 MG