VPRIV (velaglucerase)
Billing
Code: J3385
Description: Velaglucerase alfa
Unit: 100 units
Payment: $367.181
Pay quarter: Q3 2023
Dosage and Frequency
Type 1 Gaucher Disease
• 60 units/kg IV every 2 weeks
• 60 units/kg IV every 2 weeks
Calculate drug reimbursement
Total Reimbursement:
$18,682.17(ASP: $17,624.69, Margin: $1,057.48)
Code:
J3385# Units to bill:
48Prior Authorization
Prior auth criteria for VPRIV may include but is not limited to:
1. Patients must have a diagnosis of Type 1 Gaucher disease.
2. Patients must be at least 2 years of age.
3. Patients should have a platelet count of at least 50 x 109/L.
4. Patients should have an acceptable hematocrit level.
5. Patients should not be receiving enzyme replacement therapy for any other lysosomal storage disorder.
6. Patients should not have evidence of bone marrow involvement or bone marrow failure.
7. Patients should not have any active infections, including HIV.
8. Patients should not have any known hypersensitivity to VPRIV or any of its components.
9. Patients should not have evidence of cirrhosis or hepatic insufficiency.
10. Patients should not be receiving concomitant medications that are known to interfere with the metabolism of VPRIV.
Insurance prior auth guidelines:
Billable NDCs
54092-0701-04
VPRIV (TAKEDA PHARMACEUTICALS AMERICA, INC.)
400 UNITS
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