Byooviz (ranibizumab-nuna)
Billing
Code: Q5124
Description: Inj. byooviz, 0.1 mg
Unit: 0.1 mg
Payment: $199.552
Pay quarter: Q4 2023
Dosage and Frequency
Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Macular Edema Following Retinal Vein Occlusion(RVO)
• 0.5mg IVT every 1 month
Macular Edema Following Retinal Vein Occlusion(RVO)
• 0.5mg IVT every 1 month
Myopic Choroidal Neovascularization (mCNV)
• 0.5mg IVT every 1 month for up to 3 months
• 0.5mg IVT every 1 month for up to 3 months
Calculate drug reimbursement
Total Reimbursement:
$997.76(ASP: $941.28, Margin: $56.48)
Code:
Q5124# Units to bill:
5Prior Authorization
Prior auth criteria for Byooviz may include but is not limited to:
1. The patient must have a clinical diagnosis of wet age-related macular degeneration (AMD) that is confirmed by fluorescein angiography or optical coherence tomography (OCT).
2. The patient must have had an inadequate response to or intolerance to one or more other therapies.
3. The patient must not have any other active ocular diseases that could interfere with the evaluation of the effectiveness of Byooviz.
4. The patient must not have any intraocular inflammation or infection.
5. The patient must not have any contraindication to Byooviz, such as hypersensitivity to any of the components.
6. The patient must not have any prior treatment with Byooviz.
7. The patient must be at least 18 years of age.
Insurance prior auth guidelines:
Billable NDCs
64406-0019-01
Byooviz (Biogen)
0.5 mg
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