Drug IndexLemtrada (Alemtuzumab)



Billing

Code: J0202

Description: Injection, alemtuzumab

Unit: 1 MG

Payment: $2337.693

Pay quarter: Q4 2024


Covered in Part D: No


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

58468-0200-01

LEMTRADA (Genzyme Corporation)

1 VIAL, SINGLE-USE in 1 CARTON (58468-0200-1) / 1.2 mL in 1 VIAL, SINGLE-USE


58468-0357-01

LEMTRADA (Genzyme Corporation)

1 VIAL, SINGLE-USE in 1 CARTON (58468-0357-1) / 1 mL in 1 VIAL, SINGLE-USE


58468-0357-03

LEMTRADA (Genzyme Corporation)

3 VIAL, SINGLE-USE in 1 CARTON (58468-0357-3) / 1 mL in 1 VIAL, SINGLE-USE



Prior Authorization


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