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:
$148,187.94Total Reimbursement:
$153,386.40(ASP: $144,704.15, Margin: $8,682.25)
.
.# Units to bill:
480Dosage & 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
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
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