ICATIBANT 30 MG/3 ML SYRINGE

Drug Details

General

Brand Name: ICATIBANT 30 MG/3 ML SYRINGE
Generic Name: icatibant acetate
Manufacturer: FRESENIUS KABI
NDC: 63323057493
Package size: 3ML
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%

Drug Pricing

Retail Pharmacy Cost: 1660.5316
Retail Pharmacy Eff Date: 04/14/2021
Specialty Pharmacy Cost: 1558.8664
Specialty Pharmacy Eff Date: 04/14/2021
Long-term Care Pharmacy Cost: 1636.80972
Long-term Care Pharmacy Eff Date: 04/14/2021
340B Cost: 728.6006
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Effective date: 04/14/2021
PDL Class: HAE TREATMENTS
Compound-only use: No

CHIP

Effective date: 04/14/2021
Compound-only use: No

CSHCN

Effective date: 04/14/2021
Compound-only use: No