Drug IndexRadicava (edaravone)
Billing
Code: J1301
Description: Injection, edaravone, 1 mg
Unit: 1 MG
Payment: $21.832
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$1,247.47Total Reimbursement:
$1,309.92(ASP: $1,235.77, Margin: $74.15)
.
.# Units to bill:
60Dosage & Frequency
Amyotrophic Lateral Sclerosis (ALS)
Initial:
• 60mg IV daily for 14 days
Followed by a 14-day drug-free period
Subsequent:
• 60mg IV daily for 10 out of 14-day periods
Followed by a 14-day drug-free period
Initial:
• 60mg IV daily for 14 days
Followed by a 14-day drug-free period
Subsequent:
• 60mg IV daily for 10 out of 14-day periods
Followed by a 14-day drug-free period
Billable NDCs
70510-2171-02
RADICAVA (MITSUBISHI TANABE PHARMA AMERICA)
60 MG
Prior Authorization
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