Tivicay Pd Tablet, For Suspension
NDC Package 49702-255-37

View Billable Units, 11-Digit Conversion Format, and RxNorm mappings
Table of Contents
    1. Package Information
    2. Frequently Asked Questions

Package Information

Tivicay Pd (dolutegravir sodium) tablets is dolutegravir is used with other HIV medications to help control HIV infection. This formulation utilizes a tablet, for suspension delivery system. Marketed by Viiv Healthcare Company, this product is identified by NDC 49702-255 and is authorized under FDA application NDA213983.

Identification & Billing

NDC Package Code
49702-255-37
Package Description
1 BOTTLE in 1 CARTON / 60 TABLET, FOR SUSPENSION in 1 BOTTLE
Product Code
49702-255
11-Digit Billing Format
49702025537
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
1 EA
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Tivicay Pd
Non-Proprietary Name
Dolutegravir Sodium
Substance Name
Dolutegravir Sodium
Dosage Form
Tablet, For Suspension - A tablet that forms a suspension when placed in a liquid (formerly referred to as a ‘dispersible tablet’).
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
DOLUTEGRAVIR SODIUM 5 mg/1
Pharmacologic Class
Usage Information
Dolutegravir is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Dolutegravir belongs to a class of drugs known as integrase inhibitors. It blocks the virus from growing and infecting more cells. Dolutegravir is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, do all of the following: (1) continue to take all HIV medications exactly as prescribed by your doctor, (2) always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity, and (3) do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

Regulatory & Marketing

Labeler Name
Viiv Healthcare Company
Product Type
Human Prescription Drug
FDA Application #
NDA213983
Marketing Category
NDA - A product marketed under an approved New Drug Application.
Start Marketing Date
06-12-2020
Listing Expiration
12-31-2026
Exclude Flag
N
Sample Package
No

Hierarchy Structure

Code Lineage

The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

* Please review the full disclaimer at the bottom of this page.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 49702-255-37 identifies a specific commercial package of 1 bottle in 1 carton / 60 tablet, for suspension in 1 bottle of Tivicay Pd, a human prescription drug labeled by Viiv Healthcare Company. This product is billed for "EA" each discreet unit and contains an estimated amount of 1 billable units per package. This tablet, for suspension is formulated for oral use and contains dolutegravir sodium as the active substance.

Is this product currently listed with the FDA?

Yes, this product is active and verified within the NDC Directory. It was introduced to the market by Viiv Healthcare Company on June 12, 2020. The current certification is valid through December 31, 2026.

What are the primary indications for this medication?

Dolutegravir is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Dolutegravir belongs to a class of drugs known as integrase inhibitors. It blocks the virus from growing and infecting more cells. Dolutegravir is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, do all of the following: (1) continue to take all HIV medications exactly as prescribed by your doctor, (2) always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity, and (3) do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

How is this Viiv Healthcare Company product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 49702025537. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 1 total billable units per package. The table below illustrates the segment conversion from the 10-digit labeler code to the 11-digit provider format.

11-Digit Code Conversion

Billing payers usually require a 5-4-2 segment configuration. Below is the conversion from the 10-digit package format to the 11-digit billing format:

10-Digit Format (5-3-2)
49702-255-37
11-Digit CMS (5-4-2)
49702-0255-37

Note: The zero is added to the Product segment to maintain the 5-4-2 structure.