Fabrazyme (agalsidase beta)
Billing
Code: J0180
Description: Agalsidase beta injection
Unit: 1 mg
Payment: $215.378
Pay quarter: Q3 2023
Dosage and Frequency
Fabry disease
• 1mg/kg IV every 2 weeks
• 1mg/kg IV every 2 weeks
Calculate drug reimbursement
Total Reimbursement:
$18,264.05(ASP: $17,230.24, Margin: $1,033.81)
Code:
J0180# Units to bill:
80Prior Authorization
Prior auth criteria for Fabrazyme may include but is not limited to:
1. The patient must have a confirmed diagnosis of Fabry disease.
2. The patient must have a documented history of an inadequate response to enzyme replacement therapy (ERT) with agalsidase beta.
3. The patient must have a documented history of an inadequate response with ERT with agalsidase alfa.
4. The patient must not have any contraindication for Fabrazyme therapy, including known hypersensitivity to the product or to any of its components.
5. The patient’s estimated glomerular filtration rate (eGFR) must be greater than or equal to 30 mL/min/1.73m2.
Insurance prior auth guidelines:
Billable NDCs
58468-0040-01
Fabrazyme (GENZYME CORPORATION)
35 MG
58468-0041-01
Fabrazyme (GENZYME CORPORATION)
5 MG
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