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Ruconest (C1-inhibitor)


Billing

Code: J0596

Description: Injection, ruconest

Unit: 10 units

Payment: $33.020

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

hereditary angioedema (HAE)

• 50U/kg (not to exceed 4200 U) IV PRN

An additional dose may be administered within 24 hours if attack persists.

Calculate drug reimbursement


Total Reimbursement:

$14,700.50

(ASP: $13,868.40, Margin: $832.10)


Code:

J0596

# Units to bill:

420

Prior Authorization

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


• Diagnosis of hereditary angioedema (HAE)
• Age 18 years or older
• Documented history of an HAE attack within the past 30 days
• Documented history of at least four HAE attacks within the past 12 months
• Documented history of at least two HAE attacks within the past 6 months
• Patient has not responded to other FDA-approved HAE therapies
• Patient is not pregnant or breast-feeding
• Patient has not had a life-threatening reaction to the Ruconest product
• Patient has no contraindications to the use of Ruconest


Insurance prior auth guidelines:

United Healthcare

Aetna

Anthem

Cigna


Billable NDCs

68012-0350-02

Ruconest (SANTARUS PHARMACEUTICALS)

2100 Units


71274-0350-02

Ruconest (PHARMING HEALTHCARE, INC.)

2100 UNITS



Resources

Drug Enrollment Form

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