Drug IndexXolair (omalizumab)
Billing
Code: J2357
Description: Omalizumab injection
Unit: 5 MG
Payment: $39.459
Pay quarter: Q1 2024
Covered in Part D: Yes
Avg tier level: 4
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$1,282.21Total Reimbursement:
$1,183.77(ASP: $1,116.76, Margin: $67.01)
.
.# Units to bill:
30Dosage & Frequency
Asthma
Dose and frequency is determined by serum total IgE level (IU/mL) and body weight (kg)
For patients aged 12 years or older
For patients aged 6-11 years
Dose and frequency is determined by serum total IgE level (IU/mL) and body weight (kg)
For patients aged 12 years or older
Pre-treatment Serum IgE (IU/mL) | Body Weight (kg) | |||
---|---|---|---|---|
30-60 | >60-70 | >70-90 | >90-150 | |
≥30-100 | 150mg q 4 weeks | 150mg q 4 weeks | 150mg q 4 weeks | 300mg q 4 weeks |
>100-200 | 300mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 225mg q 2 weeks |
>200-300 | 300mg q 4 weeks | 225mg q 2 weeks | 225mg q 2 weeks | 300mg q 2 weeks |
>300-400 | 225mg q 2 weeks | 225mg q 2 weeks | 300mg q 2 weeks | |
>400-500 | 300mg q 2 weeks | 300mg q 2 weeks | 375mg q 2 weeks | |
>500-600 | 300mg q 2 weeks | 375mg q 2 weeks | ||
>600-700 | 375mg q 2 weeks |
For patients aged 6-11 years
Nasal Polyps
Dose and frequency is determined by serum total IgE level (IU/mL) and body weight (kg)
Dose and frequency is determined by serum total IgE level (IU/mL) and body weight (kg)
Pre-treatment Serum IgE (IU/mL) | Body Weight (kg) | |||||||
---|---|---|---|---|---|---|---|---|
>30-40 | >40-50 | >50-60 | >60-70 | >70-80 | >80-90 | >90-125 | >125-150 | |
30-100 | 75mg q 4 weeks | 150mg q 4 weeks | 150mg q 4 weeks | 150mg q 4 weeks | 150mg q 4 weeks | 150mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks |
>100-200 | 150mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 450mg q 4 weeks | 600mg q 4 weeks |
>200-300 | 225mg q 4 weeks | 300mg q 4 weeks | 300mg q 4 weeks | 450mg q 4 weeks | 450mg q 4 weeks | 450mg q 4 weeks | 600mg q 4 weeks | 375mg q 2 weeks |
>300-400 | 300mg q 4 weeks | 450mg q 4 weeks | 450mg q 4 weeks | 450mg q 4 weeks | 600mg q 4 weeks | 600mg q 4 weeks | 450mg q 2 weeks | 525mg q 2 weeks |
>400-500 | 450mg q 4 weeks | 450mg q 4 weeks | 600mg q 4 weeks | 600mg q 4 weeks | 375mg q 2 weeks | 375mg q 2 weeks | 525mg q 2 weeks | 600mg q 2 weeks |
>500-600 | 450mg q 4 weeks | 600mg q 4 weeks | 600mg q 4 weeks | 375mg q 2 weeks | 450mg q 2 weeks | 450mg q 2 weeks | 600mg q 2 weeks | |
>600-700 | 450mg q 4 weeks | 600mg q 4 weeks | 375mg q 2 weeks | 450mg q 2 weeks | 450mg q 2 weeks | 525mg q 2 weeks | ||
>700-800 | 300mg q 2 weeks | 375mg q 2 weeks | 450mg q 2 weeks | 450mg q 2 weeks | 525mg q 2 weeks | 600mg q 2 weeks | ||
>800-900 | 300mg q 2 weeks | 375mg q 2 weeks | 450mg q 2 weeks | 525mg q 2 weeks | 600mg q 2 weeks | |||
>900-1000 | 375mg q 2 weeks | 450mg q 2 weeks | 525mg q 2 weeks | 600mg q 2 weeks | ||||
>1000-1100 | 375mg q 2 weeks | 450mg q 2 weeks | 600mg q 2 weeks | |||||
>1100-1200 | 450mg q 2 weeks | 525mg q 2 weeks | 600mg q 2 weeks | |||||
>1200-1300 | 450mg q 2 weeks | 525mg q 2 weeks | ||||||
>1300-1500 | 525mg q 2 weeks | 600mg q 2 weeks |
Chronic Idiopathic Urticaria (CIU)
• 150mg or 300mg SQ every 4 weeks
• 150mg or 300mg SQ every 4 weeks
Billable NDCs
50242-0040-62
Xolair (GENENTECH, INC.)
150 MG
50242-0214-01
Xolair (GENENTECH, INC.)
75 MG
50242-0215-01
Xolair (GENENTECH, INC.)
150 MG
Prior Authorization
Resources