Cerezyme (imiglucerase)
Billing
Code: J1786
Description: Imuglucerase injection
Unit: 10 units
Payment: $44.250
Pay quarter: Q3 2023
Dosage and Frequency
Type 1 Gaucher disease
Dosage is based on disease severity ranging from:
• 2.5 units/kg IV 3 times a week
• 60 units/kg IV every 2 weeks
Dosage is based on disease severity ranging from:
• 2.5 units/kg IV 3 times a week
• 60 units/kg IV every 2 weeks
Calculate drug reimbursement
Total Reimbursement:
$11,257.20(ASP: $10,620.00, Margin: $637.20)
Code:
J1786# Units to bill:
240Prior Authorization
Prior auth criteria for Cerezyme may include but is not limited to:
1. The patient must have a confirmed diagnosis of Gaucher disease type 1, as determined by a genetic test or enzyme assay.
2. The patient must have a body weight greater than or equal to 30 kg (66 lbs).
3. The patient must have evidence of organomegaly, anemia, thrombocytopenia, or other symptoms of Gaucher disease that have not adequately responded to other treatments.
4. The patient must not have had any major organ transplantation or whole bone marrow transplantation within the past 6 months.
5. The patient must not have any active malignancies.
6. The patient must not be pregnant or lactating.
7. The patient must not have any known or suspected hypersensitivity or intolerance to Cerezyme or any of its components.
8. The patient must not have any known or suspected clinically significant hepatic or renal disease.
Insurance prior auth guidelines:
Billable NDCs
58468-4663-01
Cerezyme (GENZYME CORPORATION)
400 UNITS
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