Drug IndexXembify (Immune Globulin Subcutaneous, Human - Klhw, 20%)


Billing

Code: J1558

Description: Inj. xembify, 100 mg

Unit: 100 MG

Payment: $14.400

Pay quarter: Q3 2024

Covered in Part D: No

Drug Cost

Calculate drug cost and reimbursement


Total WAC:

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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

13533-0810-05

XEMBIFY (Grifols USA, LLC)

1 VIAL in 1 CARTON (13533-810-05) / 5 mL in 1 VIAL (13533-810-06)


13533-0810-10

XEMBIFY (Grifols USA, LLC)

1 VIAL in 1 CARTON (13533-810-10) / 10 mL in 1 VIAL (13533-810-11)


13533-0810-20

XEMBIFY (Grifols USA, LLC)

1 VIAL in 1 CARTON (13533-810-20) / 20 mL in 1 VIAL (13533-810-21)


13533-0810-50

XEMBIFY (Grifols USA, LLC)

1 VIAL in 1 CARTON (13533-810-50) / 50 mL in 1 VIAL (13533-810-51)


Prior Authorization

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