Drug IndexPulmozyme (Dornase Alfa)
Billing
Code: J7639
Description: Dornase alfa non-comp unit
Unit: 1 MG
Payment: $53.436
Pay quarter: Q3 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
50242-0100-40
Pulmozyme (Genentech, Inc.)
5 POUCH in 1 CARTON (50242-100-40) / 6 AMPULE in 1 POUCH (50242-100-39) / 2.5 mL in 1 AMPULE
Prior Authorization
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