Ilaris (canakinumab)
Billing
Code: J0638
Description: Canakinumab injection
Unit: 1 mg
Payment: $119.558
Pay quarter: Q1 2023
Dosage and Frequency
Cryopyrin-Associated Periodic Syndromes (CAPS)
• 150mg SQ every 8 weeks if patient weighs more than 40kg
• 2mg/kg SQ every 8 weeks if patient weighs between 15-40kg
• 150mg SQ every 8 weeks if patient weighs more than 40kg
• 2mg/kg SQ every 8 weeks if patient weighs between 15-40kg
Tumor Necrosis Factor Receptor (TNF) Associated Periodic Syndrome (TRAPS)
Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD)
Familial Mediterranean Fever (FMF)
• 2mg/kg SQ every 4 weeks if patient weighs 40kg or below
• 150mg SQ every 4 weeks if patient weighs more than 40kg
Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD)
Familial Mediterranean Fever (FMF)
• 2mg/kg SQ every 4 weeks if patient weighs 40kg or below
• 150mg SQ every 4 weeks if patient weighs more than 40kg
Still's Disease
• 4mg/kg (not to exceed 300mg) SQ every 4 weeks
• 4mg/kg (not to exceed 300mg) SQ every 4 weeks
Calculate drug reimbursement
Total Reimbursement:
$19,009.72(ASP: $17,933.70, Margin: $1,076.02)
Code:
J0638# Units to bill:
150Prior Authorization
Prior auth criteria for Ilaris may include but is not limited to:
Insurance prior auth guidelines:
Billable NDCs
00078-0734-61
ILARIS (NOVARTIS PHARMACEUTICALS CORPORATION)
150 MG
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