Drug IndexOrencia (abatacept)
Billing
Code: J0129
Description: Abatacept injection
Unit: 10 MG
Payment: $42.840
Pay quarter: Q2 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$4,284.60Total Reimbursement:
$3,213.00(ASP: $3,031.13, Margin: $181.87)
.
.# Units to bill:
75Dosage & Frequency
Rheumatoid Arthritis
• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 125mg SQ every 1 week
• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 125mg SQ every 1 week
Polyarticular Juvenile Idiopathic Arthritis
• 10mg/kg IV if patient weighs less than 75kg
• Follow dosage for Rheumatoid Arthritis if patient weighs greater than or equal to 75kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 50mg every 1 week if patient weighs 10-25kg
• 87.5mg every 1 week if patient weighs 25-50kg
• 125mg every 1 week if patient weighs greater than 50kg
• 10mg/kg IV if patient weighs less than 75kg
• Follow dosage for Rheumatoid Arthritis if patient weighs greater than or equal to 75kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 50mg every 1 week if patient weighs 10-25kg
• 87.5mg every 1 week if patient weighs 25-50kg
• 125mg every 1 week if patient weighs greater than 50kg
Psoriatic Arthritis (PsA)
• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 125mg SQ every 1 week
• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg
Induction:
• at weeks 0, 2, and 4
Maintenance:
• every 4 weeks
OR
• 125mg SQ every 1 week
prophylaxis of acute graft versus host disease (aGVHD)
For patients aged 6 years or older
• 10mg/kg IV (not to exceed 1000mg) on day before transplantation, and days 5, 14, and 28 after transplantation
For patients aged 2-6 years
• 15mg/kg IV on day before transplantation
• 12mg/kg IV on days 5, 14, and 28 after transplantation
For patients aged 6 years or older
• 10mg/kg IV (not to exceed 1000mg) on day before transplantation, and days 5, 14, and 28 after transplantation
For patients aged 2-6 years
• 15mg/kg IV on day before transplantation
• 12mg/kg IV on days 5, 14, and 28 after transplantation
Billable NDCs
00003-2187-13
ORENCIA (BRISTOL-MYERS SQUIBB COMPANY)
250 MG
00003-2188-11
ORENCIA (BRISTOL-MYERS SQUIBB COMPANY)
500 MG
00003-2188-51
ORENCIA CLICKJECT (BRISTOL-MYERS SQUIBB COMPANY)
500 MG
00003-2814-11
ORENCIA (BRISTOL-MYERS SQUIBB COMPANY)
200 MG
00003-2818-11
ORENCIA (BRISTOL-MYERS SQUIBB COMPANY)
350 MG
Prior Authorization
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