Drug IndexPanzyga (Immune Globulin Intravenous, Human-Ifas)
Billing
Code: J1576
Description: Inj, panzyga, 500 mg
Unit: 500 MG
Payment: $67.461
Pay quarter: Q4 2024
Covered in Part D: Yes
Avg tier level: 4
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
00069-1011-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1011-02) / 10 mL in 1 BOTTLE, GLASS (0069-1011-01)
00069-1109-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1109-02) / 25 mL in 1 BOTTLE, GLASS (0069-1109-01)
00069-1224-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1224-02) / 50 mL in 1 BOTTLE, GLASS (0069-1224-01)
00069-1312-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1312-02) / 100 mL in 1 BOTTLE, GLASS (0069-1312-01)
00069-1415-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1415-02) / 200 mL in 1 BOTTLE, GLASS (0069-1415-01)
00069-1558-02
PANZYGA (Pfizer Laboratories Div Pfizer Inc)
1 BOTTLE, GLASS in 1 CARTON (0069-1558-02) / 300 mL in 1 BOTTLE, GLASS (0069-1558-01)
68982-0822-01
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-01) / 10 mL in 1 BOTTLE, GLASS (68982-822-81)
68982-0822-02
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-02) / 25 mL in 1 BOTTLE, GLASS (68982-822-82)
68982-0822-03
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-03) / 50 mL in 1 BOTTLE, GLASS (68982-822-83)
68982-0822-04
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-04) / 100 mL in 1 BOTTLE, GLASS (68982-822-84)
68982-0822-05
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-05) / 200 mL in 1 BOTTLE, GLASS (68982-822-85)
68982-0822-06
PANZYGA (Octapharma USA Inc)
1 BOTTLE, GLASS in 1 CARTON (68982-822-06) / 300 mL in 1 BOTTLE, GLASS (68982-822-86)
Prior Authorization
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