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Boniva (ibandronate)


Billing

Code: J1740

Description: Ibandronate sodium injection

Unit: 1 mg

Payment: $24.903

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Postmenopausal Osteoporosis

• 3mg IV every 3 months

Calculate drug reimbursement


Total Reimbursement:

$74.71

(ASP: $70.48, Margin: $4.23)


Code:

J1740

# Units to bill:

3

Prior Authorization

Prior auth criteria for Boniva may include but is not limited to:


1. The patient must be 18 years of age or older.

2. The patient must have a diagnosis of postmenopausal osteoporosis, either primary or secondary, or osteoporosis associated with long-term use of glucocorticoids.

3. The patient's bone mineral density test must demonstrate a T-score of -2.5 or less.

4. The patient must not have any known hypersensitivity or contraindication to ibandronate or any of the components of the formulation.

5. The patient must not have a history of gastrointestinal disorders, including dysphagia, esophagitis, or gastric ulcers.

6. The patient must not have taken any other bisphosphonate within 7 days of the proposed Boniva treatment.

7. The patient must not have any other condition that could increase the risk of adverse events associated with Boniva.


Insurance prior auth guidelines:


Billable NDCs

00004-0191-09

BONIVA (GENENTECH, INC.)

3 MG


25021-0827-61

IBANDRONATE SODIUM (SAGENT PHARMACEUTICALS INC)

3 MG


55150-0191-83

IBANDRONATE SODIUM (AUROMEDICS PHARMA LLC)

3 MG


60505-6097-00

IBANDRONATE SODIUM (APOTEX CORP.)

3 MG


67457-0524-33

IBANDRONATE SODIUM (MYLAN INSTITUTIONAL LLC)

3 MG



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