Boniva (ibandronate)
Billing
Code: J1740
Description: Ibandronate sodium injection
Unit: 1 mg
Payment: $34.032
Pay quarter: Q1 2023
Dosage and Frequency
Postmenopausal Osteoporosis
• 3mg IV every 3 months
• 3mg IV every 3 months
Calculate drug reimbursement
Total Reimbursement:
$108.22(ASP: $102.10, Margin: $6.13)
Code:
J1740# Units to bill:
3Prior 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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