Drug IndexLeqembi (Lecanemab)
Billing
Code: J0174
Description: Inj, lecanemab-irmb, 1 mg
Unit: 1 MG
Payment: $1.336
Pay quarter: Q3 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
N/ATotal Reimbursement:
N/A(ASP: N/A, Margin: N/A)
.
.# Units to bill:
N/ABillable NDCs
62856-0212-01
LEQEMBI (Eisai Inc.)
1 VIAL, SINGLE-DOSE in 1 CARTON (62856-212-01) / 2 mL in 1 VIAL, SINGLE-DOSE
62856-0215-01
LEQEMBI (Eisai Inc.)
1 VIAL, SINGLE-DOSE in 1 CARTON (62856-215-01) / 5 mL in 1 VIAL, SINGLE-DOSE
Prior Authorization
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