Fasenra (benralizumab)
Billing
Code: J0517
Description: Inj., benralizumab, 1 mg
Unit: 1 mg
Payment: $168.248
Pay quarter: Q1 2023
Dosage and Frequency
Severe asthma
Induction:
• 30mg SQ every 4 weeks for first 3 doses
Maintenance:
• 30mg SQ every 8 weeks
Induction:
• 30mg SQ every 4 weeks for first 3 doses
Maintenance:
• 30mg SQ every 8 weeks
Calculate drug reimbursement
Total Reimbursement:
$5,350.29(ASP: $5,047.44, Margin: $302.85)
Code:
J0517# Units to bill:
30Prior Authorization
Prior auth criteria for Fasenra may include but is not limited to:
• The patient must be over the age of 18 years old.
• The patient must have been diagnosed with severe eosinophilic asthma.
• The patient must be using a high-dose inhaled corticosteroid with a long-acting beta2-agonist.
• The patient must have had inadequate control of asthma symptoms despite using other asthma medications as prescribed.
• The patient must not be pregnant or breastfeeding.
• The patient must not have any known or suspected allergy to benralizumab.
• The patient must not have an immunocompromised or immunodeficient condition.
• The patient must not be currently receiving other biologic therapies, such as omalizumab.
Insurance prior auth guidelines:
Billable NDCs
00310-1730-30
Fasenra (ASTRAZENECA)
30 MG
00310-1830-30
Fasenra (ASTRAZENECA)
30 MG
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