JIVI 2,000 UNIT VIAL

Drug Details

General

Brand Name: JIVI 2,000 UNIT VIAL
Generic Name: FVIII rec,B-dom delet peg-aucl
Manufacturer: BAYER,PHARM DIV
NDC: 00026394625
Package size: 1EA

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†: Yes
Specialty Drug Effective Date: 07/30/2021

Drug Pricing

Retail Pharmacy Cost: 2.352
Retail Pharmacy Eff Date: 01/11/2022
Specialty Pharmacy Cost: 2.208
Specialty Pharmacy Eff Date: 01/11/2022
Long-term Care Pharmacy Cost: 2.3184
Long-term Care Pharmacy Eff Date: 01/11/2022
340B Cost: 1.632
Premium Preferred Generic Incentive‡: Yes

Program Coverage

Medicaid

Effective date: 12/07/2018
Compound-only use: No
FFS Clinical PA Required‡: No
Part B Cost-share Drug**: Yes
Part D Wrap-around Drug***: No

CHIP

Effective date: 12/07/2018
Compound-only use: No

CSHCN

Effective date: 04/01/2021
Compound-only use: No