Drug IndexPrivigen (Immune Globulin Intravenous (Human), 10% Liquid)


Billing

Code: J1459

Description: Inj ivig privigen 500 mg

Unit: 500 MG

Payment: $48.671

Pay quarter: Q3 2024

Covered in Part D: Yes

Avg tier level: 4

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

44206-0436-05

Privigen (CSL Behring AG)

1 VIAL, GLASS in 1 CARTON (44206-436-05) / 50 mL in 1 VIAL, GLASS (44206-436-90)


44206-0437-10

Privigen (CSL Behring AG)

1 VIAL, GLASS in 1 CARTON (44206-437-10) / 100 mL in 1 VIAL, GLASS (44206-437-91)


44206-0438-20

Privigen (CSL Behring AG)

1 VIAL, GLASS in 1 CARTON (44206-438-20) / 200 mL in 1 VIAL, GLASS (44206-438-92)


44206-0439-40

Privigen (CSL Behring AG)

1 VIAL, GLASS in 1 CARTON (44206-439-40) / 400 mL in 1 VIAL, GLASS (44206-439-93)


Prior Authorization

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