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Oxlumo (lumasiran)


Billing

Code: J0224

Description: Injection, lumasiran, 0.5 mg

Unit: 0.5 mg

Payment: $310.899

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Primary Hyperoxaluria Type 1 (PH1)

Loading dose:
• 6mg/kg SQ every 1 month for 3 doses if patient weighs less than 20kg
• 3mg/kg SQ every 1 month for 3 doses if patient weighs 20kg or above

Maintenance:
• 3mg/kg SQ every 1 month if patient weighs less than 10kg
• 6mg/kg SQ every 3 months if patient weighs 10kg to less than 20kg
• 3mg/kg SQ every 3 months if patient weighs 20kg or above

Calculate drug reimbursement


Total Reimbursement:

$158,185.41

(ASP: $149,231.52, Margin: $8,953.89)


Code:

J0224

# Units to bill:

480

Prior Authorization

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





Insurance prior auth guidelines:


Billable NDCs

71336-1002-01

Oxlumo (ALNYLAM PHARMACEUTICALS, INC.)

94.5 MG



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