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  • Analysource Report 20210111061725

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    Vijaya Agrawa
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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    6 views37 pages

    Analysource Report 20210111061725

    Uploaded by

    Vijaya Agrawa

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 37

    Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright

    Exported: 01/11/2021
    Total NDCs: 2
    Product Filter: Brand Name (TRAZIMERA)
    Historical Price Filters: Price Date Range (WAC Unit: 01/11/2016 - 01/11/2021), Price Date Range (ASP: 01/11/2016 - 01/11/2

    NDC Brand Name Latest Price Verification Date


    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0306-01 TRAZIMERA
    permission and copyrighted by First Databank, Inc.)

    SP: 01/11/2016 - 01/11/2021)

    Current ASP Payment Limit ASP HCPCS Code Dosage


    $ 74.0230000 - 01/01/2021 10 MG
    10 MG
    10 MG
    10 MG
    Current WAC Package WAC Package Quantity
    $ 3391.0800000 - 02/18/2020 1
    1
    1
    1
    WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
    Vial $ 3391.0800000 - 02/18/20201
    Vial 1
    Vial 1
    Vial 1
    WAC Unit Unit of Measure Generic Name Strength
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    trastuzumab-qyyp 420 mg
    Dosage Form Package Size Unit Dose Indicator
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    Unit of Use Indicator ASP HCPCS Code WAC Unit Effective Date
    Non Unit of Use Products Q5116 02/18/2020
    Non Unit of Use Products Q5116
    Non Unit of Use Products Q5116
    Non Unit of Use Products Q5116
    Non Unit of Use Products Not On File
    WAC Unit Price WAC Unit Quantity WAC Unit Unit of Measure
    3391.0800000 1 Each

    Not On File
    WAC Unit Price Change WAC Unit Percent Change
    WAC Unit Filter Start Date WAC Unit Start Price
    01/11/2016 No Data
    01/11/2016 No Data
    01/11/2016 No Data
    01/11/2016 No Data
    01/11/2016 No Data
    WAC Unit Filter End Date WAC Unit End Price
    01/11/2021 3391.0800000
    01/11/2021 3391.0800000
    01/11/2021 3391.0800000
    01/11/2021 3391.0800000
    01/11/2021 No Data
    ASP Payment Limit Effective Date ASP Payment Limit
    01/01/2021 74.0230000
    10/01/2020 83.1040000
    07/01/2020 83.1620000
    04/01/2020 83.1620000
    Not On File Not On File
    ASP HCPCS Code Dosage ASP Payment Limit Change
    10 MG -9.0810000
    10 MG -.0580000
    10 MG .0000000
    10 MG
    Not On File
    ASP Payment Limit Percent Change ASP Filter Start Date
    -10.93 01/11/2016
    -.07 01/11/2016
    .00 01/11/2016
    01/11/2016
    01/11/2016
    ASP Start Price ASP Filter End Date ASP End Price
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 No Data
    Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright
    Exported: 01/11/2021
    Total NDCs: 2
    Product Filter: Brand Name (TRAZIMERA)
    Historical Price Filters: Price Date Range (WAC Unit: 01/11/2016 - 01/11/2021), Price Date Range (ASP: 01/11/2016 - 01/11/2

    NDC Brand Name Latest Price Verification Date


    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0306-01 TRAZIMERA
    permission and copyrighted by First Databank, Inc.)

    SP: 01/11/2016 - 01/11/2021)

    Current ASP Payment Limit ASP HCPCS Code Dosage


    $ 74.0230000 - 01/01/2021 10 MG
    Current WAC Package WAC Package Quantity
    $ 3391.0800000 - 02/18/2020 1
    WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
    Vial $ 3391.0800000 - 02/18/20201
    WAC Unit Unit of Measure Generic Name Strength
    Each trastuzumab-qyyp 420 mg
    trastuzumab-qyyp 420 mg
    Dosage Form Package Size Unit Dose Indicator
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    Unit of Use Indicator ASP HCPCS Code WAC Unit Effective Date
    Non Unit of Use Products Q5116 02/18/2020
    Non Unit of Use Products Not On File
    WAC Unit Price WAC Unit Quantity WAC Unit Unit of Measure
    3391.0800000 1 Each
    Not On File
    WAC Unit Price Change WAC Unit Percent Change
    WAC Unit Filter Start Date WAC Unit Start Price
    01/11/2016 No Data
    01/11/2016 No Data
    WAC Unit Filter End Date WAC Unit End Price
    01/11/2021 3391.0800000
    01/11/2021 No Data
    Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright
    Exported: 01/11/2021
    Total NDCs: 2
    Product Filter: Brand Name (TRAZIMERA)
    Historical Price Filters: Price Date Range (WAC Unit: 01/11/2016 - 01/11/2021), Price Date Range (ASP: 01/11/2016 - 01/11/2

    NDC Brand Name Latest Price Verification Date


    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0305-01 TRAZIMERA 02/18/2020
    00069-0306-01 TRAZIMERA
    permission and copyrighted by First Databank, Inc.)

    SP: 01/11/2016 - 01/11/2021)

    Current ASP Payment Limit ASP HCPCS Code Dosage


    $ 74.0230000 - 01/01/2021 10 MG
    10 MG
    10 MG
    10 MG
    Current WAC Package WAC Package Quantity
    $ 3391.0800000 - 02/18/2020 1
    1
    1
    1
    WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
    Vial $ 3391.0800000 - 02/18/20201
    Vial 1
    Vial 1
    Vial 1
    WAC Unit Unit of Measure Generic Name Strength
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    Each trastuzumab-qyyp 420 mg
    trastuzumab-qyyp 420 mg
    Dosage Form Package Size Unit Dose Indicator
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    VIAL (EA) 1.000 Non Unit Dose Products
    Unit of Use Indicator ASP HCPCS Code
    Non Unit of Use Products Q5116
    Non Unit of Use Products Q5116
    Non Unit of Use Products Q5116
    Non Unit of Use Products Q5116
    Non Unit of Use Products
    ASP Payment Limit Effective Date ASP Payment Limit
    01/01/2021 74.0230000
    10/01/2020 83.1040000
    07/01/2020 83.1620000
    04/01/2020 83.1620000
    Not On File Not On File
    ASP HCPCS Code Dosage ASP Payment Limit Change
    10 MG -9.0810000
    10 MG -.0580000
    10 MG .0000000
    10 MG
    Not On File
    ASP Payment Limit Percent Change ASP Filter Start Date
    -10.93 01/11/2016
    -.07 01/11/2016
    .00 01/11/2016
    01/11/2016
    01/11/2016
    ASP Start Price ASP Filter End Date ASP End Price
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 74.0230000
    No Data 01/11/2021 No Data

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