Drug IndexBenlysta (belimumab)
Billing
Code: J0490
Description: Belimumab injection
Unit: 10 MG
Payment: $54.102
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$4,087.33Total Reimbursement:
$4,328.16(ASP: $4,083.17, Margin: $244.99)
.
.# Units to bill:
80Dosage & Frequency
Systemic Lupus Erythematosus (SLE)
Induction:
• 10mg/kg IV every 2 weeks for the first 3 doses
Maintenance:
• 10mg/kg IV every 4 weeks
OR
• 200mg SQ every 1 week
Induction:
• 10mg/kg IV every 2 weeks for the first 3 doses
Maintenance:
• 10mg/kg IV every 4 weeks
OR
• 200mg SQ every 1 week
Lupus Nephritis
Induction:
• 10mg/kg IV every 2 weeks for the first 3 doses
Maintenance:
• 10mg/kg IV every 4 weeks
OR
Induction:
• 400mg SQ every 2 weeks for the first 4 doses
Maintenance:
• 200mg SQ every 1 week
Induction:
• 10mg/kg IV every 2 weeks for the first 3 doses
Maintenance:
• 10mg/kg IV every 4 weeks
OR
Induction:
• 400mg SQ every 2 weeks for the first 4 doses
Maintenance:
• 200mg SQ every 1 week
Billable NDCs
49401-0101-01
BENLYSTA (GLAXOSMITHKLINE)
120 MG
49401-0102-01
BENLYSTA (GLAXOSMITHKLINE)
400 MG
Prior Authorization
Resources