Drug IndexTzield (Teplizumab-Mzwv)



Billing

Code: J9381

Description: Inj teplizumab mzwv 5 mcg

Unit: 5 MCG

Payment: $36.380

Pay quarter: Q2 2024


Covered in Part D: No


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

73650-0316-01

TZIELD (Provention Bio, Inc.)

1 VIAL, SINGLE-DOSE in 1 CARTON (73650-316-01) / 2 mL in 1 VIAL, SINGLE-DOSE


73650-0316-10

TZIELD (Provention Bio, Inc.)

10 VIAL, SINGLE-DOSE in 1 CARTON (73650-316-10) / 2 mL in 1 VIAL, SINGLE-DOSE


73650-0316-14

TZIELD (Provention Bio, Inc.)

14 VIAL, SINGLE-DOSE in 1 CARTON (73650-316-14) / 2 mL in 1 VIAL, SINGLE-DOSE



Prior Authorization


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