Cinryze (C1-inhibitor)
Billing
Code: J0598
Description: C-1 esterase, cinryze
Unit: 10 units
Payment: $60.725
Pay quarter: Q4 2023
Dosage and Frequency
Hereditary Angioedema (HAE)
• 1000IU IV every 3-4 days if patient's age is 12 years or older
• 500IU IV every 3-4 days if patient's age is 6-11 years
• 1000IU IV every 3-4 days if patient's age is 12 years or older
• 500IU IV every 3-4 days if patient's age is 6-11 years
Calculate drug reimbursement
Total Reimbursement:
$6,072.50(ASP: $5,728.77, Margin: $343.73)
Code:
J0598# Units to bill:
100Prior Authorization
Prior auth criteria for Cinryze may include but is not limited to:
• The patient must have a confirmed diagnosis of HAE based on current clinical evaluation and laboratory testing.
• The patient must have a history of at least two episodes of HAE in the past 6 months.
• The patient must not have had any serious adverse reactions to Cinryze in the past.
• The patient must not have any contraindications to Cinryze therapy.
• The patient must not be pregnant, nursing, or planning to become pregnant.
• The patient must be under the supervision of a physician experienced in the diagnosis and management of HAE.
Insurance prior auth guidelines:
Billable NDCs
42227-0081-05
Cinryze (TAKEDA PHARMACEUTICAL AMERICA, INC.)
500 UNITS
42227-0083-01
Cinryze (TAKEDA PHARMACEUTICAL AMERICA, INC.)
500 UNITS
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