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Givlaari (givosiran)


Billing

Code: J0223

Description: Inj givosiran 0.5 mg

Unit: 0.5 mg

Payment: $109.817

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Acute Hepatic Porphyria (AHP)

• 2.5mg/kg SQ every 1 month

Calculate drug reimbursement


Total Reimbursement:

$46,562.41

(ASP: $43,926.80, Margin: $2,635.61)


Code:

J0223

# Units to bill:

400

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

71336-1001-01

Givlaari (ALNYLAM PHARMACEUTICALS, INC.)

189 MG



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