Cimerli (ranibizumab-eqrn)
Billing
Code: Q5128
Description: Inj, cimerli, 0.1 mg
Unit: 0.1 mg
Payment: $273.264
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
Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)
• 0.3mg IVT every 1 month
Diabetic Retinopathy (DR)
• 0.3mg 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:
$1,366.32(ASP: $1,288.98, Margin: $77.34)
Code:
Q5128# Units to bill:
5Prior Authorization
Prior auth criteria for Cimerli may include but is not limited to:
Insurance prior auth guidelines:
Billable NDCs
70114-0440-01
Cimerli (Coherus Biosciences, Inc.)
0.30000000000000004 MG
70114-0441-01
Cimerli (Coherus Biosciences, Inc.)
0.5 MG
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