Drug IndexZemaira (Alpha1-Proteinase Inhibitor (Human))



Billing

Code: J0256

Description: Alpha 1 proteinase inhibitor

Unit: 10 MG

Payment: $4.935

Pay quarter: Q4 2024


Covered in Part D: Yes

Avg tier level: 4


Drug Cost

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Total WAC:

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Total Reimbursement:

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# Units to bill:

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Billable NDCs

00053-7201-02

Zemaira (CSL Behring LLC)

1 KIT in 1 CARTON (0053-7201-02) * 20 mL in 1 VIAL, SINGLE-DOSE (0053-7211-01) * 20 mL in 1 VIAL, SINGLE-DOSE (0053-7653-20)


00053-7202-02

Zemaira (CSL Behring LLC)

1 KIT in 1 CARTON (0053-7202-02) * 76 mL in 1 VIAL, SINGLE-USE (0053-7212-01) * 76 mL in 1 VIAL, SINGLE-USE (0053-7653-80)


00053-7203-02

Zemaira (CSL Behring LLC)

1 KIT in 1 CARTON (0053-7203-02) * 95 mL in 1 VIAL, SINGLE-USE (0053-7213-01) * 95 mL in 1 VIAL, SINGLE-USE (0053-7653-12)



Prior Authorization


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