Hemophilia Enhanced Specialty Discount Products ANTIDIURETIC
Hemophilia Enhanced Specialty Discount Products Therapeutic Group Label Name ANTIDIURETIC AND VASOPRESSOR HORMONES ANTIDIURETIC AND VASOPRESSOR HORMONES ANTIFIBRINOLYTIC ANTIFIBRINOLYTIC ANTIFIBRINOLYTIC ANTIFIBRINOLYTIC ANTIHEMOPHILIC VIII/VWF COMP ANTIHEMOPHILIC VIII/VWF COMP ANTIHEMOPHILIC VIII/VWF COMP ANTIHEMOPHILIC VIII/VWF COMP ANTI-INHIBITOR ANTI-INHIBITOR ANTI-INHIBITOR STIMATE 1.5 MG/ML NASAL SPRAY STIMATE 4 MCG/ML VIAL AMICAR 1,000 MG TABLET AMICAR 25% SOLUTION AMICAR 250 MG/ML VIAL AMICAR 500 MG TABLET ALPHANATE 1,000-400 UNIT VIAL ALPHANATE 1,500-600 UNIT VIAL ALPHANATE 250-100 UNIT VIAL ALPHANATE 500-200 UNIT VIAL FEIBA NF 1,000 UNIT (NOMINAL) FEIBA NF 1,750-3,250 UNIT VIAL FEIBA NF 400-650 UNIT VIAL BEBULIN 200-1,200 UNITS VIAL PROFILNINE SD 1,000 UNITS VIAL PROFILNINE SD 1,500 UNITS VIAL PROFILNINE SD 500 UNITS VIAL ALPHANINE SD 1,000 UNITS VIAL ALPHANINE SD 1,500 UNITS VIAL ALPHANINE SD 500 UNITS VIAL MONONINE 1,000 UNITS KIT ALPROLIX 1,000 UNIT NOMINAL ALPROLIX 2,000 UNIT NOMINAL ALPROLIX 3,000 UNIT NOMINAL ALPROLIX 500 UNIT NOMINAL BENEFIX 1,000 UNIT KIT BENEFIX 2,000 UNIT KIT BENEFIX 250 UNIT KIT BENEFIX 3,000 UNIT KIT BENEFIX 500 UNIT KIT RIXUBIS 1,000 UNIT NOMINAL RIXUBIS 2,000 UNIT NOMINAL RIXUBIS 250 UNIT NOMINAL RIXUBIS 3,000 UNIT NOMINAL RIXUBIS 500 UNIT NOMINAL NOVOSEVEN RT 1 MG VIAL NOVOSEVEN RT 2 MG VIAL NOVOSEVEN RT 5 MG VIAL NOVOSEVEN RT 8 MG VIAL HEMOFIL M 1,000 UNIT NOMINAL HEMOFIL M 1,700 UNIT NOMINAL HEMOFIL M 250 UNIT NOMINAL HEMOFIL M 500 UNIT NOMINAL KOATE-DVI 1,000 UNITS VIAL KOATE-DVI 250 UNITS VIAL KOATE-DVI 500 UNITS KIT KOATE-DVI 500 UNITS VIAL MONOCLATE-P 1,000 UNITS KIT MONOCLATE-P 1,500 UNITS KIT XYNTHA 1,000 UNIT KIT XYNTHA 2,000 UNIT KIT XYNTHA 250 UNIT KIT XYNTHA 3,000 UNIT SYRINGE KIT XYNTHA 500 UNIT KIT XYNTHA SOLOFUSE 1,000 UNIT KIT XYNTHA SOLOFUSE 2,000 UNIT KIT XYNTHA SOLOFUSE 250 UNIT KIT XYNTHA SOLOFUSE 500 UNIT KIT ADVATE 1,201-1,800 UNITS VIAL ADVATE 1,801-2,400 UNITS VIAL ADVATE 2,401-3,600 UNITS VIAL ADVATE 200-400 UNITS VIAL ADVATE 3,601-4,800 UNITS VIAL ADVATE 401-800 UNITS VIAL ADVATE 801-1,200 UNITS VIAL ELOCTATE 1,000 UNIT NOMINAL ELOCTATE 1,500 UNIT NOMINAL ELOCTATE 2,000 UNIT NOMINAL ELOCTATE 250 UNIT NOMINAL ELOCTATE 3,000 UNIT NOMINAL ELOCTATE 500 UNIT NOMINAL ELOCTATE 750 UNIT NOMINAL HELIXATE FS 1,000 UNIT VIAL HELIXATE FS 2,000 UNIT VIAL HELIXATE FS 250 UNIT VIAL HELIXATE FS 3,000 UNITS VIAL HELIXATE FS 500 UNIT VIAL KOGENATE FS 1,000 UNIT VIAL KOGENATE FS 2,000 UNIT VIAL KOGENATE FS 250 UNIT VIAL KOGENATE FS 3,000 UNIT VIAL KOGENATE FS 500 UNIT VIAL RECOMBINATE 1,241-1,800 UNIT V CORIFACT KIT CORIFACT KIT TRETTEN 2,500 UNIT VIAL HUMATE-P 1,200 UNIT VWF:RCO HUMATE-P 2,400 UNIT VWF:RCO HUMATE-P 600 UNIT VWF:RCO WILATE 1,000-1,000 UNIT KIT WILATE 500-500 UNIT KIT FACTOR IX COMPLEX FACTOR IX COMPLEX FACTOR IX COMPLEX FACTOR IX COMPLEX FACTOR IX NON-RECOMBINANT FACTOR IX NON-RECOMBINANT FACTOR IX NON-RECOMBINANT FACTOR IX NON-RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR IX RECOMBINANT FACTOR VIIA FACTOR VIIA FACTOR VIIA FACTOR VIIA FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR VIII RECOMBINANT NOS FACTOR XIII CONCENTRATE, HUMAN FACTOR XIII CONCENTRATE, HUMAN FACTOR XIII RECOMBINANT Additional Label Names with GCN DESMOPRESSIN 40 MCG/10 ML VIAL AMINOCAPROIC ACID 1,000 MG TAB AMICAR 25% SYRUP AMINOCAPROIC ACID 250 MG/ML AMINOCAPROIC ACID 500 MG TAB DESMOPRESSIN AC 4 MCG/ML VIAL FEIBA NF 651-1,200 UNIT VIAL FEIBA NF 2,500 UNIT (NOMINAL) FEIBA NF 500 UNIT (NOMINAL) FEIBA VH IMMUNO 651-1,200 UNIT KOGENATE FS 1,000 UNITS VIAL KOGENATE FS 2,000 UNIT VIAL KOGENATE FS 250 UNIT VIAL KOGENATE FS 3,000 UNITS VIAL KOGENATE FS 500 UNIT VIAL RECOMBINATE 801-1,240 UNIT VL RECOMBINATE 1,801-2,400 UNIT V RECOMBINATE 220-400 UNIT VIAL DDAVP 4 MCG/ML VIAL AMINOCAPROIC ACID 25% SOLUTION AMINOCAPROIC ACID 250 MG/ML FEIBA VH IMMUNO 400-650 UNITS RECOMBINATE 401-800 UNIT VIAL VON WILLEBRAND FACTOR (HP-VWF/FVIII) CONCENTRATE VON WILLEBRAND FACTOR (HP-VWF/FVIII) CONCENTRATE VON WILLEBRAND FACTOR (HP-VWF/FVIII) CONCENTRATE VON WILLEBRAND FACTOR/COAGULATION FACTOR VIII COMPLEX (HUMAN) VON WILLEBRAND FACTOR/COAGULATION FACTOR VIII COMPLEX (HUMAN) *The maximum reimbursement is WAC + 1.0%. **Calculated as a straight average rather than a weighted average of the WAC equivalents for active, rebateable NDCs within the GCN due to these GCNs not having any North Carolina utilization data. ***Set at WAC + 0. 7% based on other Factor XIII products. No PBM benchmarks or utilization data available due to recent commercial release ****Set at WAC + 1.0% based on reimbursement in Specialty SMAC 1 of 1 WAC Equivalent 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% -8.9% -8.9% -8.9% -8.9% -8.5% -8.5% -8.5% -2.0% -2.0% -2.0% -2.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% -8.9% -8.9% -8.9% -8.9% -11.7% -11.7% -11.7% -11.7% -11.7% -11.7% -11.7% -11.7% -11.7% -11.7% -5.7% -5.7% -5.7% -5.7% -5.7% -5.7% -5.7% -5.7% -5.7% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% -7.2% 0.7% 0.7% 0.7% -11.7% -11.7% -11.7% -6.2% -6.2%
© Copyright 2024