Drug IndexOxlumo (lumasiran)



Billing

Code: J0224

Description: Inj. lumasiran, 0.5 mg

Unit: 0.5 MG

Payment: $319.555

Pay quarter: Q1 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$148,187.94

Total Reimbursement:

$153,386.40

(ASP: $144,704.15, Margin: $8,682.25)

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# Units to bill:

480

Dosage & 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


Billable NDCs

71336-1002-01

Oxlumo (ALNYLAM PHARMACEUTICALS, INC.)

94.5 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

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