Xembify - CuraFi

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Xembify (SCIG)

Billing

Code: J1558

Description: Inj. xembify, 100 mg

Unit: 0.1 g

Payment: $13.971

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$4,191.30

(ASP: $3,954.06, Margin: $237.24)

Code:

J1558

# Units to bill:

300

Prior Authorization

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

1. The patient must have a diagnosis of a condition that is indicated for Xembify.
2. The patient must meet the criteria for treatment with Xembify according to the prescribing information.
3. The patient must have tried and failed, contraindicated, or not tolerated an appropriate alternative or adjunctive therapy.
4. The patient must not have any contraindications to the use of Xembify.
5. The patient must meet all applicable benefit plan criteria for the use of Xembify.
6. The patient must be enrolled in a drug coverage program that covers Xembify.
7. The patient must be monitored for clinical response and potential adverse effects, and dose adjustments must be made as appropriate.
8. The patient must meet all applicable prior authorization criteria as set forth by the insurance plan.

Insurance prior auth guidelines:

Billable NDCs

13533-0810-05

Xembify (GRIFOLS USA, LLC)

1000 MG

13533-0810-10

Xembify (GRIFOLS USA, LLC)

2000 MG