Givlaari (givosiran)
Billing
Code: J0223
Description: Inj givosiran 0.5 mg
Unit: 0.5 mg
Payment: $109.817
Pay quarter: Q1 2023
Dosage and Frequency
Acute Hepatic Porphyria (AHP)
• 2.5mg/kg SQ every 1 month
• 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:
400Prior 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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