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Ilaris (canakinumab)


Billing

Code: J0638

Description: Canakinumab injection

Unit: 1 mg

Payment: $119.558

Pay quarter: Q1 2023


Medicare history

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

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

Still's Disease

• 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:

150

Prior 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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