Drug IndexEylea (aflibercept)
Billing
Code: J0178
Description: Aflibercept injection
Unit: 1 MG
Payment: $862.280
Pay quarter: Q1 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$1,850.00Total Reimbursement:
$1,724.56(ASP: $1,626.94, Margin: $97.62)
.
.# Units to bill:
2Dosage & Frequency
Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Induction:
• 2mg IVT every 1 month for the first 3 months
Maintenance:
• 2mg IVT every 2 months
Induction:
• 2mg IVT every 1 month for the first 3 months
Maintenance:
• 2mg IVT every 2 months
Macular Edema Following Retinal Vein Occlusion (RVO)
• 2mg IVT every 1 month
• 2mg IVT every 1 month
Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)
Induction:
• 2mg IVT every 1 month for the first 5 injections
Maintenance:
• 2mg IVT every 2 months
Diabetic Retinopathy (DR)
Induction:
• 2mg IVT every 1 month for the first 5 injections
Maintenance:
• 2mg IVT every 2 months
Billable NDCs
61755-0005-01
Eylea (REGENERON PHARMACEUTICALS INC.)
2 MG
61755-0005-02
EYLEA (REGENERON PHARMACEUTICALS INC.)
2 MG
Prior Authorization
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