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Fasenra (benralizumab)


Billing

Code: J0517

Description: Inj., benralizumab, 1 mg

Unit: 1 mg

Payment: $170.925

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

Severe asthma

Induction:
• 30mg SQ every 4 weeks for first 3 doses

Maintenance:
• 30mg SQ every 8 weeks

Calculate drug reimbursement


Total Reimbursement:

$5,435.42

(ASP: $5,127.75, Margin: $307.67)


Code:

J0517

# Units to bill:

30

Prior 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:

Aetna

United Healthcare

Cigna

Anthem


Billable NDCs

00310-1730-30

Fasenra (ASTRAZENECA)

30 MG


00310-1830-30

Fasenra (ASTRAZENECA)

30 MG



Resources

Drug Enrollment Form

Website