Saphnelo (anifrolumab)
Billing
Code: J0491
Description: Inj anifrolumab-fnia 1mg
Unit: 1 mg
Payment: $16.316
Pay quarter: Q1 2023
Dosage and Frequency
Systemic Lupus Erythematosus (SLE)
• 300mg IV every 4 weeks
• 300mg IV every 4 weeks
Calculate drug reimbursement
Total Reimbursement:
$5,188.49(ASP: $4,894.80, Margin: $293.69)
Code:
J0491# Units to bill:
300Prior Authorization
Prior auth criteria for Saphnelo may include but is not limited to:
1. Diagnosis of Systemic Lupus Erythematosus (SLE) based on the American College of Rheumatology criteria.
2. Patient must be at least 18 years of age.
3. Patient has not responded adequately to other treatments for SLE, including but not limited to immunosuppressive medicines, antimalarial medicines, and/or NSAIDs.
4. Patient does not have an active infection or an uncontrolled medical condition.
5. Patient does not have an allergy or intolerance to Saphnelo or any of its components.
6. Patient has not had a history of organ transplantation.
7. Patient has not had an allergic reaction to biologic therapies.
Insurance prior auth guidelines:
Billable NDCs
00310-3040-00
Saphnelo (ASTRAZENECA)
300 mg
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