Drug IndexAvsola (infliximab-axxq)



Billing

Code: Q5121

Description: Inj. avsola, 10 mg

Unit: 10 MG

Payment: $25.555

Pay quarter: Q1 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$1,500.00

Total Reimbursement:

$766.65

(ASP: $723.25, Margin: $43.40)

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# Units to bill:

30

Dosage & Frequency

Crohn's Disease (CD)
Ulcerative Colitis (UC)
Ankylosing Spondylitis (AS)
Psoriatic Arthritis (PsA)
Plaque Psoriasis (Ps)

Induction:
• 5mg/kg IV at 0, 2, and 6 weeks

Maintenance:
• 5mg/kg IV every 8 weeks

Rheumatoid Arthritis (RA)

Induction:
• 3mg/kg IV at 0, 2, and 6 weeks

Maintenance:
• 3mg/kg IV every 8 weeks


Billable NDCs

55513-0670-01

Avsola (AMGEN USA, INC.)

100 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

Drug Enrollment Form

Website