Oxlumo (lumasiran)
Billing
Code: J0224
Description: Injection, lumasiran, 0.5 mg
Unit: 0.5 mg
Payment: $310.899
Pay quarter: Q1 2023
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
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:
480Prior 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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