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Kalbitor (ecallantide)


Billing

Code: J1290

Description: Ecallantide injection

Unit: 1 mg

Payment: $516.600

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Acute attacks of hereditary angioedema (HAE)

• 30mg SQ PRN

An additional dose may be administered within 24 hours if attack persists.

Calculate drug reimbursement


Total Reimbursement:

$16,427.88

(ASP: $15,498.00, Margin: $929.88)


Code:

J1290

# Units to bill:

30

Prior Authorization

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


1. Patient is 6 years of age or older.
2. Patient has been diagnosed with hereditary angioedema (HAE).
3. Patient has failed or is intolerant to other treatments for HAE, such as fresh frozen plasma, C1-inhibitor concentrate, or danazol.
4. Patient has documented response to Kalbitor treatment.
5. Patient has no contraindications for Kalbitor.
6. Patient has not experienced any serious adverse reactions to Kalbitor.
7. Patient is prescribed a course of treatment that is no longer than 8 days.
8. Patient is not pregnant or nursing.


Insurance prior auth guidelines:

United Healthcare

Cigna

Aetna

Anthem


Billable NDCs

47783-0101-01

KALBITOR (TAKEDA PHARMACEUTICALS AMERICA, INC.)

30 MG



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