Lucentis - CuraFi

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Lucentis (ranibizumab)

Billing

Code: J2778

Description: Ranibizumab injection

Unit: 0.1 mg

Payment: $237.195

Pay quarter: Q1 2023

Dosage and Frequency

Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Macular Edema Following Retinal Vein Occlusion (RVO)

• 0.5mg IVT every 1 month

Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)

• 0.3mg IVT every 1 month

Myopic Choroidal Neovascularization (mCNV)

• 0.5mg IVT every 1 month for up to 3 months

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$1,257.13

(ASP: $1,185.98, Margin: $71.16)

Code:

J2778

# Units to bill:

Prior Authorization

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

1. The patient must have a diagnosis of neovascular (wet) age-related macular degeneration (AMD) or macular edema following central retinal vein occlusion (CRVO).
2. The patient must have evidence of recent disease activity as determined by the presence of intraretinal or/and subretinal fluid.
3. The patient must have best corrected visual acuity of 20/40 or worse in the affected eye.
4. The patient must not have received prior treatment with either intravitreal anti-vascular endothelial growth factor therapy or photodynamic therapy within the previous 6 months.
5. The patient must not have any contraindication to treatment with Lucentis.
6. The patient must not have any concurrent conditions that may interfere with the safety or efficacy of Lucentis therapy.

Insurance prior auth guidelines:

Billable NDCs

50242-0080-02

Lucentis (GENENTECH, INC.)

0.5 mg

50242-0080-03

Lucentis (GENENTECH, INC.)

0.5 mg