Zolgensma (onasemnogene abeparvovec-xioi)
Payment: Claims for J3399 must be manually adjudicated
Pay quarter: N/A
Dosage and Frequency
• 1.1 x 10^14 vector genomes per kg IV
Calculate drug reimbursement
(ASP: N/A, Margin: N/A)
# Units to bill:N/A
Prior auth criteria for Zolgensma may include but is not limited to:
1. The patient must have a genetic diagnosis of spinal muscular atrophy (SMA) type 1 that is confirmed by genetic testing.
2. The patient must have a clinical diagnosis of spinal muscular atrophy type 1.
3. The patient must have at least two SMN2 copies.
4. The patient must not have received prior treatment with gene therapy, nusinersen, or other approved treatments for SMA.
5. The patient must be less than 2 years of age at the time of initial administration.
6. The patient must have a creatinine clearance of at least 70 ml/min/1.73m2.
7. The patient must not have any concomitant illnesses that would preclude the safe administration of Zolgensma.
Insurance prior auth guidelines: