Drug IndexCimzia (certolizumab pegol)
Billing
Code: J0717
Description: Certolizumab pegol inj 1mg
Unit: 1 MG
Payment: $4.624
Pay quarter: Q2 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$5,719.19Total Reimbursement:
$1,849.60(ASP: $1,744.91, Margin: $104.69)
.
.# Units to bill:
400Dosage & Frequency
Crohn's Disease (CD)
Induction:
• 400mg SQ at weeks 0, 2, and 4
Maintenance:
• 400mg SQ every 4 weeks
Induction:
• 400mg SQ at weeks 0, 2, and 4
Maintenance:
• 400mg SQ every 4 weeks
Rheumatoid Arthritis (RA)
Psoriatic Arthritis (PsA)
Ankylosing Spondylitis (AS)
Non-Radiographic Axial Spondyloarthritis (nr-axSpA)
Induction:
• 400mg SQ at weeks 0, 2, and 4
Maintenance:
• 200mg SQ every 2 weeks or 400mg SQ every 4 weeks
Psoriatic Arthritis (PsA)
Ankylosing Spondylitis (AS)
Non-Radiographic Axial Spondyloarthritis (nr-axSpA)
Induction:
• 400mg SQ at weeks 0, 2, and 4
Maintenance:
• 200mg SQ every 2 weeks or 400mg SQ every 4 weeks
Plaque Psoriasis (PsO)
• 400mg SQ every 2 weeks
• 400mg SQ every 2 weeks
Billable NDCs
50474-0700-62
CIMZIA (UCB, INC.)
400 MG
50474-0710-79
CIMZIA (UCB, INC.)
400 MG
50474-0710-81
CIMZIA (UCB, INC.)
1200 MG
Prior Authorization
Resources