AJOVY 225 MG/1.5 ML SYRINGE

Drug Details

General

Brand Name: AJOVY 225 MG/1.5 ML SYRINGE
Generic Name: fremanezumab-vfrm
Manufacturer: TEVA USA
NDC: 51759020410
Package size: 1.5ML

Drug Information

Family Planning drug: No
Diabetic Supply Drug: No
HTW drug: No
HTWPlus drug: No
Long-acting reversible contraception product: No
Refill-to-soon Utilization*: 75%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: 470.3835
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 462.15178
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 459.09429
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 210.17253
Premium Preferred Generic Incentive‡: No

* Impacts only claims paid by HHSC: traditional Medicaid, CSHCN, HTW, and KHC Programs.

† Refer to the Specialty Drug Handbook for more information..

‡ Refer to the Premium Preferred Generic Drugs section for information about traditional Medicaid claim pricing and PPG pricing incentives.