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Tezspire (tezepelumab-ekko)


Billing

Code: J2356

Description: Inj tezepelumab-ekko, 1mg

Unit: 1 mg

Payment: $18.729

Pay quarter: Q3 2023


Medicare history

Dosage and Frequency

Severe asthma

• 210mg SQ every 4 weeks

Calculate drug reimbursement


Total Reimbursement:

$4,169.08

(ASP: $3,933.09, Margin: $235.99)


Code:

J2356

# Units to bill:

210

Prior Authorization

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


1. The patient must be 18 years of age or older.

2. The patient must have a diagnosis of a chronic or acute condition that is indicated by Tezspire.

3. The patient must have failed to respond adequately to conventional treatments.

4. The patient must have had no adverse reactions to Tezspire in the past.

5. The patient must have a valid prescription for Tezspire.

6. The patient must have the appropriate laboratory tests and/or imaging studies to confirm the diagnosis.

7. The patient must have completed all necessary pre-treatment evaluations recommended by their healthcare provider.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

55513-0112-01

Tezspire (AMGEN INC.)

210 MG


55513-0123-01

TEZSPIRE (AMGEN INC.)

210 MG



Resources

Drug Enrollment Form

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