Monoferric (ferric derisomaltose)
Billing
Code: J1437
Description: Inj. fe derisomaltose 10 mg
Unit: 10 mg
Payment: $20.613
Pay quarter: Q3 2023
Dosage and Frequency
Iron Deficiency Anemia (IDA)
• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg
• 1000mg IV if patient weighs 50kg or more
• 20mg/kg IV if patient weighs less than 50kg
Calculate drug reimbursement
Total Reimbursement:
$2,184.98(ASP: $2,061.30, Margin: $123.68)
Code:
J1437# Units to bill:
100Prior Authorization
Prior auth criteria for Monoferric may include but is not limited to:
1. The patient must have iron deficiency anemia (IDA) that is confirmed by laboratory testing.
2. The patient must have an absolute deficiency of iron, as demonstrated by a ferritin level less than or equal to 30 ng/mL or an iron saturation less than or equal to 20%.
3. The patient must have failed or cannot tolerate oral iron therapy.
4. The patient must not have any contraindications to the use of intravenous iron therapy, including known hypersensitivity to Monoferric or any of its components.
5. The patient must not have received an intravenous iron product within the last 8 weeks prior to treatment.
6. The patient must meet the criteria for any applicable cost-sharing, such as copayments and deductibles.
Insurance prior auth guidelines:
Billable NDCs
73594-9310-01
Monoferric (PHARMACOSMOS THERAPEUTICS)
1000 MG
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