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

Exported: 01/12/2021
Total NDCs: 2
Product Filter: Brand Name (HERCEPTIN)
Historical Price Filters: Price Date Range (WAC Unit: 01/01/2015 - 01/01/2021), Price Date Range (ASP: 01/01/2015 - 01/05/2

NDC Brand Name Latest Price Verification Date

50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
permission and copyrighted by First Databank, Inc.)

SP: 01/01/2015 - 01/05/2021)

Current ASP Payment Limit ASP HCPCS Code Dosage

$ 97.9210000 - 01/01/2021 10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
$ 97.9210000 - 01/01/2021 10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
Current WAC Package WAC Package Quantity
$ 1558.4200000 - 07/01/2018 1
1
1
1
1
1
1
1
1
1
1
1
1
1
$ 1558.4200000 - 06/03/2019 1
1
1
1
1
1
WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
Vial $ 1558.4200000 - 07/01/20181
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 1558.4200000 - 06/03/20191
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
WAC Unit Unit of Measure Generic Name Strength
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 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
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
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
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 J9355 07/01/2018
Non Unit of Use Products J9355 01/01/2018
Non Unit of Use Products J9355 07/01/2017
Non Unit of Use Products J9355 05/30/2017
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355 06/03/2019
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
WAC Unit Price WAC Unit Quantity WAC Unit Unit of Measure
1558.4200000 1 Each
1513.0300000 1 Each
1468.9600000 1 Each
1426.1700000 1 Each

1558.4200000 1 Each
WAC Unit Price Change WAC Unit Percent Change
45.3900000 3.00
44.0700000 3.00
42.7900000 3.00
WAC Unit Filter Start Date WAC Unit Start Price
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
WAC Unit Filter End Date WAC Unit End Price
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
ASP Payment Limit Effective Date ASP Payment Limit
01/01/2021 97.9210000
10/01/2020 99.6750000
07/01/2020 102.3170000
04/01/2020 104.1990000
01/01/2020 105.8550000
10/01/2019 106.6220000
07/01/2019 106.9750000
04/01/2019 107.0220000
01/01/2019 106.9950000
10/01/2018 104.1230000
07/01/2018 103.7280000
04/01/2018 101.0470000
01/01/2018 100.6520000
10/01/2017 97.8030000
01/01/2021 97.9210000
10/01/2020 99.6750000
07/01/2020 102.3170000
04/01/2020 104.1990000
01/01/2020 105.8550000
10/01/2019 106.6220000
ASP HCPCS Code Dosage ASP Payment Limit Change
10 MG -1.7540000
10 MG -2.6420000
10 MG -1.8820000
10 MG -1.6560000
10 MG -.7670000
10 MG -.3530000
10 MG -.0470000
10 MG .0270000
10 MG 2.8720000
10 MG .3950000
10 MG 2.6810000
10 MG .3950000
10 MG 2.8490000
10 MG
10 MG -1.7540000
10 MG -2.6420000
10 MG -1.8820000
10 MG -1.6560000
10 MG -.7670000
10 MG
ASP Payment Limit Percent Change ASP Filter Start Date
-1.76 01/01/2015
-2.58 01/01/2015
-1.81 01/01/2015
-1.56 01/01/2015
-.72 01/01/2015
-.33 01/01/2015
-.04 01/01/2015
.03 01/01/2015
2.76 01/01/2015
.38 01/01/2015
2.65 01/01/2015
.39 01/01/2015
2.91 01/01/2015
01/01/2015
-1.76 01/01/2015
-2.58 01/01/2015
-1.81 01/01/2015
-1.56 01/01/2015
-.72 01/01/2015
01/01/2015
ASP Start Price ASP Filter End Date ASP End Price
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright
Exported: 01/12/2021
Total NDCs: 2
Product Filter: Brand Name (HERCEPTIN)
Historical Price Filters: Price Date Range (WAC Unit: 01/01/2015 - 01/01/2021), Price Date Range (ASP: 01/01/2015 - 01/05/2

NDC Brand Name Latest Price Verification Date

50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-10 HERCEPTIN 05/28/2019
permission and copyrighted by First Databank, Inc.)

SP: 01/01/2015 - 01/05/2021)

Current ASP Payment Limit ASP HCPCS Code Dosage

$ 97.9210000 - 01/01/2021 10 MG
10 MG
10 MG
10 MG
$ 97.9210000 - 01/01/2021 10 MG
Current WAC Package WAC Package Quantity
$ 1558.4200000 - 07/01/2018 1
1
1
1
$ 1558.4200000 - 06/03/2019 1
WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
Vial $ 1558.4200000 - 07/01/20181
Vial 1
Vial 1
Vial 1
Vial $ 1558.4200000 - 06/03/20191
WAC Unit Unit of Measure Generic Name Strength
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 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 J9355 07/01/2018
Non Unit of Use Products J9355 01/01/2018
Non Unit of Use Products J9355 07/01/2017
Non Unit of Use Products J9355 05/30/2017
Non Unit of Use Products J9355 06/03/2019
WAC Unit Price WAC Unit Quantity WAC Unit Unit of Measure
1558.4200000 1 Each
1513.0300000 1 Each
1468.9600000 1 Each
1426.1700000 1 Each
1558.4200000 1 Each
WAC Unit Price Change WAC Unit Percent Change
45.3900000 3.00
44.0700000 3.00
42.7900000 3.00
WAC Unit Filter Start Date WAC Unit Start Price
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
01/01/2015 No Data
WAC Unit Filter End Date WAC Unit End Price
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
01/01/2021 1558.4200000
Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright
Exported: 01/12/2021
Total NDCs: 2
Product Filter: Brand Name (HERCEPTIN)
Historical Price Filters: Price Date Range (WAC Unit: 01/01/2015 - 01/01/2021), Price Date Range (ASP: 01/01/2015 - 01/05/2

NDC Brand Name Latest Price Verification Date

50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-01 HERCEPTIN 06/30/2018
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
50242-0132-10 HERCEPTIN 05/28/2019
permission and copyrighted by First Databank, Inc.)

SP: 01/01/2015 - 01/05/2021)

Current ASP Payment Limit ASP HCPCS Code Dosage

$ 97.9210000 - 01/01/2021 10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
$ 97.9210000 - 01/01/2021 10 MG
10 MG
10 MG
10 MG
10 MG
10 MG
Current WAC Package WAC Package Quantity
$ 1558.4200000 - 07/01/2018 1
1
1
1
1
1
1
1
1
1
1
1
1
1
$ 1558.4200000 - 06/03/2019 1
1
1
1
1
1
WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
Vial $ 1558.4200000 - 07/01/20181
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 1558.4200000 - 06/03/20191
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
WAC Unit Unit of Measure Generic Name Strength
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 mg
Each trastuzumab 150 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
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
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
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 J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
Non Unit of Use Products J9355
ASP Payment Limit Effective Date ASP Payment Limit
01/01/2021 97.9210000
10/01/2020 99.6750000
07/01/2020 102.3170000
04/01/2020 104.1990000
01/01/2020 105.8550000
10/01/2019 106.6220000
07/01/2019 106.9750000
04/01/2019 107.0220000
01/01/2019 106.9950000
10/01/2018 104.1230000
07/01/2018 103.7280000
04/01/2018 101.0470000
01/01/2018 100.6520000
10/01/2017 97.8030000
01/01/2021 97.9210000
10/01/2020 99.6750000
07/01/2020 102.3170000
04/01/2020 104.1990000
01/01/2020 105.8550000
10/01/2019 106.6220000
ASP HCPCS Code Dosage ASP Payment Limit Change
10 MG -1.7540000
10 MG -2.6420000
10 MG -1.8820000
10 MG -1.6560000
10 MG -.7670000
10 MG -.3530000
10 MG -.0470000
10 MG .0270000
10 MG 2.8720000
10 MG .3950000
10 MG 2.6810000
10 MG .3950000
10 MG 2.8490000
10 MG
10 MG -1.7540000
10 MG -2.6420000
10 MG -1.8820000
10 MG -1.6560000
10 MG -.7670000
10 MG
ASP Payment Limit Percent Change ASP Filter Start Date
-1.76 01/01/2015
-2.58 01/01/2015
-1.81 01/01/2015
-1.56 01/01/2015
-.72 01/01/2015
-.33 01/01/2015
-.04 01/01/2015
.03 01/01/2015
2.76 01/01/2015
.38 01/01/2015
2.65 01/01/2015
.39 01/01/2015
2.91 01/01/2015
01/01/2015
-1.76 01/01/2015
-2.58 01/01/2015
-1.81 01/01/2015
-1.56 01/01/2015
-.72 01/01/2015
01/01/2015
ASP Start Price ASP Filter End Date ASP End Price
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000
No Data 01/05/2021 97.9210000