Nexviazyme (avalglucosidase alfangpt)
Billing
Code: J0219
Description: Inj aval alfa-nqpt 4mg
Unit: 4 mg
Payment: $75.038
Pay quarter: Q3 2023
Dosage and Frequency
Pompe disease
• 20mg/kg IV every 2 weeks if patient weighs 30kg or more
• 40mg/kg IV every 2 weeks if patient weighs less than 30kg
• 20mg/kg IV every 2 weeks if patient weighs 30kg or more
• 40mg/kg IV every 2 weeks if patient weighs less than 30kg
Calculate drug reimbursement
Total Reimbursement:
$31,816.11(ASP: $30,015.20, Margin: $1,800.91)
Code:
J0219# Units to bill:
400Prior Authorization
Prior auth criteria for Nexviazyme may include but is not limited to:
1. The patient must be diagnosed with an inherited disorder of glycosylation (IDG) and have a confirmed deficiency of the enzyme alpha-N-acetylglucosaminidase (NAG).
2. The patient must be aged 18 months or older and have a body weight of at least 10 kg.
3. The patient must have failed conventional treatments and not have any contraindications to treatment with Nexviazyme.
4. The patient must not have had any hypersensitivity reactions to the drug.
5. The patient must have a documented history of adherence to previous therapies.
6. The patient must have documentation of the medical necessity for Nexviazyme therapy.
Insurance prior auth guidelines:
Billable NDCs
58468-0426-01
Nexviazyme (GENZYME CORPORATION)
100 mg
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