JIVI 500 UNIT VIAL

Drug Details

General

Brand Name: JIVI 500 UNIT VIAL
Generic Name: FVIII rec,B-dom delet peg-aucl
Manufacturer: BAYER,PHARM DIV
NDC: 00026394225
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

Drug Pricing

Retail Pharmacy Cost: 2.7048
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 2.5392
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 2.66616
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 1.8768
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.