Cuvitru - CuraFi

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Cuvitru (SCIG)

Billing

Code: J1555

Description: Inj cuvitru, 100 mg

Unit: 0.1 g

Payment: $15.725

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$4,717.50

(ASP: $4,450.47, Margin: $267.03)

Code:

J1555

# Units to bill:

300

Prior Authorization

Prior auth criteria for Cuvitru may include but is not limited to:

1. Patient must have a primary immunodeficiency disease as diagnosed by a healthcare provider.
2. Patient has been prescribed a course of treatment with Cuvitru.
3. Patient has not received a dose of Cuvitru within the past 28 days.
4. Patient is aged 2 years or older.
5. Patient has not been previously diagnosed with a secondary immunodeficiency disorder.
6. Patient has not been prescribed another immune globulin product in the past 28 days.
7. Patient has not been prescribed any products containing IgG in the past 28 days.
8. Patient has not had any severe allergic reactions to any immune globulin products.
9. Patient does not have any active infections or any other medical conditions that would contraindicate the use of Cuvitru.
10. Patient has not had any significant changes in weight since their last treatment with Cuvitru.

Insurance prior auth guidelines:

Billable NDCs

00944-2850-01

CUVITRU (TAKEDA PHARMACEUTICALS AMERICA, INC.)

1000 MG

00944-2850-03

CUVITRU (TAKEDA PHARMACEUTICALS AMERICA, INC.)

2000 MG