Injectafer (ferric carboxymaltose)
Billing
Code: J1439
Description: Inj ferric carboxymaltos 1mg
Unit: 1 mg
Payment: $1.125
Pay quarter: Q3 2023
Dosage and Frequency
Iron Deficiency Anemia (IDA)
• Two doses of 750mg IV separated by at least 7 days if patient weighs 50kg or more
• Two doses of 15mg/kg IV separated by at least 7 days if patient weighs less than 50kg
• Two doses of 750mg IV separated by at least 7 days if patient weighs 50kg or more
• Two doses of 15mg/kg IV separated by at least 7 days if patient weighs less than 50kg
Calculate drug reimbursement
Total Reimbursement:
$894.38(ASP: $843.75, Margin: $50.63)
Code:
J1439# Units to bill:
750Prior Authorization
Prior auth criteria for Injectafer may include but is not limited to:
1. The patient must be 18 years of age or older.
2. The patient must have a diagnosis of iron deficiency anemia (IDA) as defined by laboratory tests.
3. The patient must have failed or not tolerated oral iron therapy.
4. The patient must not have evidence of active infection or inflammation.
5. The patient must not have any known hypersensitivity to the active ingredients or excipients of Injectafer.
6. The patient must not have iron overload syndrome.
7. The patient must not have a history of congestive heart failure, chronic kidney disease, hepatic disease, uncontrolled hypertension, or any other medical condition that might increase their risk of adverse effects from Injectafer.
8. The patient must not be pregnant or breastfeeding.
9. The patient must have documentation of appropriate laboratory tests to monitor iron levels before and after treatment with Injectafer.
10. The patient must have documentation of an adequate response to oral iron therapy prior to receiving Injectafer.
Insurance prior auth guidelines:
Billable NDCs
00517-0602-01
INJECTAFER (AMERICAN REGENT)
100 MG
00517-0650-01
Injectafer (AMERICAN REGENT)
0 1mg
Resources