Privigen - CuraFi

Back to drug list

Privigen (IVIG)

Billing

Code: J1459

Description: Inj ivig privigen 500 mg

Unit: 0.5 g

Payment: $47.589

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$2,855.34

(ASP: $2,693.72, Margin: $161.62)

Code:

J1459

# Units to bill:

Prior Authorization

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

1. Patient must have a diagnosis of primary immunodeficiency (PID) as defined by the World Health Organization (WHO).

2. Patient must be ? 2 years of age and weigh more than 10 kg.

3. Patient must have an IgG level <500 mg/dL or a documented history of an episode of infection requiring intravenous immunoglobulin (IVIG) replacement therapy.

4. Patient must be intolerant to other IVIG treatments or have an inadequate response to other IVIG treatments.

5. Patient must have not received a Privigen infusion within the past 6 months.

6. Patient must not have any history of thromboembolic or cardiovascular events.

7. The prescribing provider must have completed a Privigen Risk Evaluation and Mitigation Strategy (REMS) program.

Insurance prior auth guidelines:

Billable NDCs

44206-0436-05

Privigen (CSL BEHRING LLC)

5000 MG

44206-0437-10

Privigen (CSL BEHRING LLC)

10000 MG