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Remicade (infliximab)


Billing

Code: J1745

Description: Infliximab not biosimil 10mg

Unit: 10 mg

Payment: $32.907

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

Crohn's Disease (CD)
Ulcerative Colitis (UC)
Ankylosing Spondylitis (AS)
Psoriatic Arthritis (PsA)
Plaque Psoriasis (Ps)

Induction:
• 5mg/kg IV at 0, 2, and 6 weeks

Maintenance:
• 5mg/kg IV every 8 weeks

Rheumatoid Arthritis (RA)

Induction:
• 3mg/kg IV at 0, 2, and 6 weeks

Maintenance:
• 3mg/kg IV every 8 weeks

Calculate drug reimbursement


Total Reimbursement:

$1,046.44

(ASP: $987.21, Margin: $59.23)


Code:

J1745

# Units to bill:

30

Prior Authorization

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


1. The patient must have been diagnosed with an appropriate condition that requires treatment with Remicade.
2. The patient must have failed an adequate trial of conventional therapy.
3. The patient must have documentation of their medical history, including lab results and any other pertinent information.
4. The patient must not have any contraindications for use of Remicade.
5. The patient must have documentation of a recent physical exam, including height, weight, and vital signs.
6. The patient must have a current laboratory test result indicating an appropriate response to the medication.
7. The patient must have a signed treatment agreement from their physician.
8. The patient must have a signed informed consent from their physician.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

57894-0030-01

Remicade (JANSSEN BIOTECH, INC.)

100 MG


57894-0160-01

INFLIXIMAB (JANSSEN BIOTECH, INC.)

100 MG



Resources

Drug Enrollment Form

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