Drug IndexSoliris (eculizumab)
Billing
Code: J1300
Description: Eculizumab injection
Unit: 10 MG
Payment: $225.703
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$19,569.00Total Reimbursement:
$20,313.27(ASP: $19,163.46, Margin: $1,149.81)
.
.# Units to bill:
90Dosage & Frequency
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Induction:
• 600mg IV every week for the first 4 doses
• 900mg IV for the fifth dose
Maintenance:
• 900mg IV every 2 weeks
Induction:
• 600mg IV every week for the first 4 doses
• 900mg IV for the fifth dose
Maintenance:
• 900mg IV every 2 weeks
Atypical Hemolytic Uremic Syndrome (aHUS)
Generalized Myasthenia Gravis (gMG)
Neuromyelitis Optica Spectrum Disorder (NMOSD)
Induction:
• 900mg IV every week for the first 4 doses
• 1200mg IV for the fifth dose
Maintenance:
• 1200mg IV every 2 weeks
Generalized Myasthenia Gravis (gMG)
Neuromyelitis Optica Spectrum Disorder (NMOSD)
Induction:
• 900mg IV every week for the first 4 doses
• 1200mg IV for the fifth dose
Maintenance:
• 1200mg IV every 2 weeks
Billable NDCs
25682-0001-01
Soliris (ALEXION PHARMACEUTICALS)
300 MG
Prior Authorization
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