Ruconest (C1-inhibitor)
Billing
Code: J0596
Description: Injection, ruconest
Unit: 10 units
Payment: $31.701
Pay quarter: Q1 2023
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.
• 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:
$14,113.29(ASP: $13,314.42, Margin: $798.87)
Code:
J0596# Units to bill:
420Prior 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:
Billable NDCs
68012-0350-02
Ruconest (SANTARUS PHARMACEUTICALS)
2100 Units
71274-0350-02
Ruconest (PHARMING HEALTHCARE, INC.)
2100 UNITS
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