Rituxan (rituximab)
Billing
Code: J9312
Description: Inj., rituximab, 10 mg
Unit: 10 mg
Payment: $81.037
Pay quarter: Q3 2023
Dosage and Frequency
Rheumatoid Arthritis (RA)
• Two 1000mg IV doses separated by 2 weeks, every 6 months
• Two 1000mg IV doses separated by 2 weeks, every 6 months
Calculate drug reimbursement
Total Reimbursement:
$8,589.92(ASP: $8,103.70, Margin: $486.22)
Code:
J9312# Units to bill:
100Prior Authorization
Prior auth criteria for Rituxan may include but is not limited to:
1. Rituximab must be used for the treatment of a diagnosed, documented B-cell NHL, CLL, or FL that has failed to respond to, or is contraindicated or not tolerated to, other therapies.
2. Patient must be 12 years of age or older.
3. The patient must have adequate organ function as demonstrated by laboratory values as specified below:
• Absolute neutrophil count > 1,000/mm3
• Platelet count > 50,000/mm3
• Total bilirubin < 1.5 x the upper limit of normal (ULN)
• Creatinine < 1.5 x ULN
• AST/ALT < 2.5 x ULN
4. The patient must not have had a prior response or have been previously treated with rituximab.
5. The patient must not be pregnant or breastfeeding.
6. The patient must not have any active infections requiring treatment.
7. The patient must not have any known hypersensitivity to murine proteins.
Insurance prior auth guidelines:
Billable NDCs
50242-0051-10
Rituxan (GENENTECH, INC.)
1000 MG
50242-0051-21
Rituxan (GENENTECH, INC.)
100 MG
50242-0053-06
Rituxan (GENENTECH, INC.)
500 MG
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