Genentech

POLIVY - Cost

Last Updated: April 1st, 2024

HCPCS:

J9309

HCPCS Code Descriptor:

Injection, polatuzumab vedotin-piiq, 1 mg

Medicare Payment Limit:

The POLIVY Medicare Payment Limit is $124.033

Average Sale Price:

POLIVY ASP cost available once logged in.

Medicare Co-Insurance Percentage:

The POLIVY Medicare Co-insurance percentage is 20%. POLIVY's Medicare Co-insurance amount is $24.81 per HCPCS unit.

APC Code:

The Polivy APC Code is: 9331

APC Payment Limit:

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

Polivy Cost Information:

POLIVY, became effective on January 1, 2020 and is aligned to HCPCS J9309. POLIVY has two NDCs mapped to J9309 without issue. Between 2022 and 2024, AWP increased by just over 5% while WAC experienced a larger increase of nearly 13%. ASP has also trended upwards by an estimated 10% over this period.

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Polivy’s wholesale acquisition cost (WAC) information was last updated on:
January 1, 2024
Polivy’s average wholesale price (AWP) information was last updated on:
January 1, 2024

Polivy Cost Graph: