XOLAIR 75 MG/0.5 ML SYRINGE

Drug Details

General

Brand Name: XOLAIR 75 MG/0.5 ML SYRINGE
Generic Name: omalizumab
Manufacturer: GENENTECH, INC.
NDC: 50242021401
Package size: .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: 1357.2608
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 1274.1632
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 1337.87136
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 595.5328
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.