Ferrlecit - CuraFi

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Ferrlecit (Sodium ferric gluconate complex)

Billing

Code: J2916

Description: Na ferric gluconate complex

Unit: 12.5 mg

Payment: $2.123

Pay quarter: Q3 2023

Dosage and Frequency

Iron Deficiency Anemia (IDA)

• 125mg IV
• 1.5mg/kg IV for pediatric patients

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$22.50

(ASP: $21.23, Margin: $1.27)

Code:

J2916

# Units to bill:

Prior Authorization

Prior auth criteria for Ferrlecit may include but is not limited to:

1. Ferrlecit is indicated for the treatment of iron deficiency anemia in adult patients with non-dialysis dependent chronic kidney disease (CKD).

2. Ferrlecit is indicated for the treatment of iron deficiency anemia in adult patients who have had inadequate response to oral iron therapy.

3. Ferrlecit is indicated for the treatment of iron deficiency anemia in adult patients who are intolerant to oral iron therapy.

4. Ferrlecit must be prescribed by a physician who is familiar with the management of CKD and anemia.

5. Ferrlecit should be used only in patients who have demonstrated an inadequate response to or intolerance of oral iron therapy.

6. Ferrlecit should be used only when the potential benefit of the intravenous iron therapy is expected to outweigh the potential risks.

7. Ferrlecit should not be used in patients with an active infection.

8. Ferrlecit should not be used in patients with known hypersensitivity to iron dextran or other ingredients of Ferrlecit.

Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Billable NDCs

00024-2792-10

Ferrlecit (SANOFI-AVENTIS)

625 MG

00024-2794-10

Ferrlecit (SANOFI-AVENTIS)

625 MG

00143-9298-10