Actavis

DALVANCE - Cost

Last Updated: April 1st, 2024

HCPCS:

J0875

HCPCS Code Descriptor:

Injection, dalbavancin, 5 mg

Medicare Payment Limit:

The DALVANCE Medicare Payment Limit is $15.122

Average Sale Price:

DALVANCE ASP cost available once logged in.

Medicare Co-Insurance Percentage:

The DALVANCE Medicare Co-insurance percentage is 20%. DALVANCE's Medicare Co-insurance amount is $3.02 per HCPCS unit.

APC Code:

The Dalvance APC Code is: 1823

APC Payment Limit:

The APC Payment Limit for DALVANCE is available. Login to view.

Dalvance Cost Information:

DALVANCE, manufactured by Actavis, became effective on January 1, 2016, and is aligned to HCPCS J0875. From 2022 through 2024, AWP and WAC experienced slight increases of a few percentage points in 2023 and the start of 2024. ASP has trended around 15% below WAC during this time.

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Dalvance’s wholesale acquisition cost (WAC) information was last updated on:
January 2, 2024
Dalvance’s average wholesale price (AWP) information was last updated on:
January 2, 2024