UL ULTRA-RARE / ORPHAN Product Name Package Size
UL ULTRA-RARE / ORPHAN Product Name Package Size
NDC # Presentation Product Category
Subcategory
Derivation
Manufacturer
NDC # Presentation Product Category
Subcategory
Derivation
Manufacturer
BAXTER HEALTHCARE CORPORATION BAXTER HEALTHCARE CORPORATION BAXTER HEALTHCARE CORPORATION
SNAKE BITE
TISSEEL
2 ML
00338-4301-02
EACH ULTRA RARE/ ORPHAN
BIOSURGICAL
PLASMA
1 CARTON = 1 VIAL
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
MCKESSON SPECIALTY CARE DISTRIBUTION
ANAVIP
66621-0790-02
VIAL
SNAKE BITE
RECOMBINANT
TISSEEL
4 ML
00338-4302-04 EACH ULTRA RARE/ ORPHAN
BIOSURGICAL
PLASMA
TISSEEL
10 ML
00338-4303-10
EACH ULTRA RARE/ ORPHAN
BIOSURGICAL
PLASMA
CROFAB
2 ML
50633-0110-12 CARTON, 2 VIALS PER
SNAKE BITE
BTG INTERNATIONAL, INC.
CHRONIC GOUT (PEGLOTICASE INJECTION)
HEREDITARY ANGIOEDEMA (HAE)
ULTRA RARE/ ORPHAN
ULTRA RARE/ ORPHAN
HEREDITARY ANGIOEDEMA (HAE)
KRYSTEXXA
2 ML
75987-0080-10
VIAL
CHRONIC GOUT
RECOMBINANT
HORIZON THERAPEUTICS
BERINERT
500 UNITS 63833-0825-02
VIAL
PLASMA
CSL BEHRING LLC
GENERALIZED MYASTHENIA GRAVIS (GMG)
PROTEIN C DEFICIENCY
GENERALIZED MYASTHENIA GRAVIS GENERALIZED MYASTHENIA GRAVIS GENERALIZED MYASTHENIA GRAVIS
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
PROTEIN C DEFICIENCY PROTEIN C DEFICIENCY
TAKEDA PHARMACEUTICALS AMERICAS, INC. TAKEDA PHARMACEUTICALS AMERICAS, INC.
RYSTIGGO
280 MG 50474-0980-79 EACH ULTRA RARE/ ORPHAN
UCB, INC.
CEPROTIN
500 IU
00944-4177-05
VIAL
PLASMA
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
MONOCLONAL ANTIBODY MONOCLONAL ANTIBODY
VYVGART
20 ML
73475-3041-05
VIAL
ARGENX US, INC.
CEPROTIN
1000 IU
00944-4179-10
VIAL
PLASMA
VYVGART HYTRULO
5.6 ML
73475-3102-03
VIAL
ARGENX US, INC.
ULCERATIVE COLITIS / CROHN'S DISEASE / RHEUMATOID ARTHRITIS
ALPHA-PROTEINASE INHIBITOR (A,PI)
ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS ULCERATIVE COLITIS/CROHN’S DISEASE/ RHEUMATOID ARTHRITIS
ULTRA RARE/ ORPHAN
MONOCLONAL ANTIBODY
TAKEDA PHARMACEUTICALS AMERICAS, INC.
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
ALPHA-PROTEINASE INHIBITOR ALPHA-PROTEINASE INHIBITOR ALPHA-PROTEINASE INHIBITOR
ENTYVIO
300MG 20ML 64764-0300-20
VIAL
ZEMAIRA
1000 MG 00053-7201-02
VIAL
PLASMA
CSL BEHRING LLC
ZEMAIRA
4000 MG
00053-7202-02
VIAL
PLASMA
CSL BEHRING LLC
ULTRA RARE/ ORPHAN
MONOCLONAL ANTIBODY
ZEMAIRA
5000 MG 00053-7203-02
VIAL
PLASMA
CSL BEHRING LLC
INFLECTRA
20 ML
00069-0809-01
VIAL
PFIZER, INC.
SPECIALTY
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
EPKINLY
4 MG 82705-0002-01
VIAL
SPECIALTY
EPCORITAMAB
GENMAB US, INC.
CIMZIA LYOPHILIZED POWDER
ULTRA RARE/ ORPHAN
2 X 200 MG 50474-0700-62
VIAL
RECOMBINANT
UCB, INC.
EPKINLY
48 MG 82705-0010-01
VIAL
SPECIALTY
EPCORITAMAB
GENMAB US, INC.
TELAVANCIN HYDROCHLORIDE
CUMBERLAND PHARMACEUTICALS, INC. ASTRAZENECA PHARMACEUTICALS, LP. ASTRAZENECA PHARMACEUTICALS, LP.
VIBATIV
750 MG 66220-0315-22 CASE, 12 VIALS ULTRA RARE/ ORPHAN
SPECIALTY
ULTRA RARE/ ORPHAN
ULTRA RARE/ ORPHAN ULTRA RARE/ ORPHAN
CIMZIA
2 X 200 MG PFS 50474-0710-79 SYRINGE
RECOMBINANT
UCB, INC.
ULTOMIRIS
300 MG / 3 ML 25682-0025-01
VIAL
SPECIALTY
RAVULIZUMAB
ULTOMIRIS
1100 MG / 11 ML 25682-0028-01
VIAL
SPECIALTY
RAVULIZUMAB
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ULTRA RARE/ ORPHAN
CIMZIA
6 X 200 MG PFS 50474-0710-81
SYRINGE
RECOMBINANT
UCB, INC.
INTRAVENOUS SOLUTION RECONSTITUTED 100 MG
SINGLE DOSE VIAL
ULTRA RARE/ ORPHAN
RENFLEXIS
78206-0162-01
ORAGNON
RHEUMATOLOGY
2 X 160 MG/ML SINGLE-DOSE PREFILLED SY- RINGES 2 X 160 MG/ML SINGLE-DOSE AUTOINJECTORS
SINGLE-DOSE PREFILLED SYRINGES
ULTRA RARE/ ORPHAN RHEUMATOLOGY
SINGLE-DOSE PREFILLED SYRINGES
BIMZELX
50474-0780-79
UCB, INC.
ULTRA RARE/ ORPHAN RHEUMATOLOGY
SINGLE-DOSE AUTOINJECTORS
BIMZELX
50474-0781-85 SINGLE DOSE AUTOINJECTORS
UCB, INC.
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH)
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH)
ULTRA RARE/ ORPHAN
ASTRAZENECA PHARMACEUTICALS, LP.
SOLIRIS
300MG/ML
25682-0001-01
VIAL
BIOSURGICAL
BAXTER HEALTHCARE CORPORATION BAXTER HEALTHCARE CORPORATION
FLOSEAL
5ML
85412-5237-38
EACH ULTRA RARE/ ORPHAN EACH ULTRA RARE/ ORPHAN
BIOSURGICAL
PLASMA
TISSEEL
SD VALUPAK 2 ML 00338-4210-02
BIOSURGICAL
PLASMA
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