Drug IndexActemra (tocilizumab)
Billing
Code: J3262
Description: Tocilizumab injection
Unit: 1 MG
Payment: $6.042
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$3,541.09Total Reimbursement:
$3,383.52(ASP: $3,192.00, Margin: $191.52)
.
.# Units to bill:
560Dosage & Frequency
Rheumatoid Arthritis (RA)
Induction:
• 4mg/kg IV every 4 weeks
Maintenance:
• 4mg/kg or 8mg/kg IV every 4 weeks
OR
Induction:
• 162mg SQ every 2 weeks if patient weighs less than 100kg
• 162mg SQ every 1 week if patient weighs greater than or equal to 100kg
Maintenance:
• 162mg SQ every 2 weeks or every 1 week
Induction:
• 4mg/kg IV every 4 weeks
Maintenance:
• 4mg/kg or 8mg/kg IV every 4 weeks
OR
Induction:
• 162mg SQ every 2 weeks if patient weighs less than 100kg
• 162mg SQ every 1 week if patient weighs greater than or equal to 100kg
Maintenance:
• 162mg SQ every 2 weeks or every 1 week
Giant Cell Arteritis (GCA)
• 6mg/kg IV every 4 weeks
OR
• 162mg SQ every 1 week
• 6mg/kg IV every 4 weeks
OR
• 162mg SQ every 1 week
Systemic Sclerosis-Associated Interstitial Lung Disease (SSc-ILD)
• 162mg SQ every 1 week
• 162mg SQ every 1 week
Polyarticular Juvenile Idiopathic Arthritis (PJIA)
• 10mg/kg IV every 4 weeks if patient weighs less than 30kg
• 8mg/kg IV every 4 weeks if patient weighs greater than or equal to 30kg
OR
• 162mg SQ every 3 weeks if patient weighs less than 30kg
• 162mg SQ every 2 weeks if patient weighs greater than or equal to 30kg
• 10mg/kg IV every 4 weeks if patient weighs less than 30kg
• 8mg/kg IV every 4 weeks if patient weighs greater than or equal to 30kg
OR
• 162mg SQ every 3 weeks if patient weighs less than 30kg
• 162mg SQ every 2 weeks if patient weighs greater than or equal to 30kg
Systemic Juvenile Idiopathic Arthritis (SJIA)
• 12mg/kg IV every 2 weeks if patient weighs less than 30kg
• 8mg/kg IV every 2 weeks if patient weighs greater than or equal to 30kg
OR
• 162mg SQ every 2 weeks if patient weighs less than 30kg
• 162mg SQ every 1 week if patient weighs greater than or equal to 30kg
• 12mg/kg IV every 2 weeks if patient weighs less than 30kg
• 8mg/kg IV every 2 weeks if patient weighs greater than or equal to 30kg
OR
• 162mg SQ every 2 weeks if patient weighs less than 30kg
• 162mg SQ every 1 week if patient weighs greater than or equal to 30kg
Cytokine Release Syndrome (CRS)
• 12mg/kg IV if patient weighs less than 30kg
• 8mg/kg IV if patient weighs greater than or equal to 30kg
Up to 3 additional dosages may be administered depending on clinical response, with at least 8 hours in between each consecutive dose.
• 12mg/kg IV if patient weighs less than 30kg
• 8mg/kg IV if patient weighs greater than or equal to 30kg
Up to 3 additional dosages may be administered depending on clinical response, with at least 8 hours in between each consecutive dose.
Billable NDCs
50242-0135-01
Actemra (GENENTECH, INC.)
80 MG
50242-0136-01
Actemra (GENENTECH, INC.)
200 MG
50242-0137-01
Actemra (GENENTECH, INC.)
400 MG
Prior Authorization
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