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Fabrazyme (agalsidase beta)


Billing

Code: J0180

Description: Agalsidase beta injection

Unit: 1 mg

Payment: $217.597

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Fabry disease

• 1mg/kg IV every 2 weeks

Calculate drug reimbursement


Total Reimbursement:

$17,407.76

(ASP: $16,422.42, Margin: $985.34)


Code:

J0180

# Units to bill:

80

Prior Authorization

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


1. The patient must have a confirmed diagnosis of Fabry disease.
2. The patient must have a documented history of an inadequate response to enzyme replacement therapy (ERT) with agalsidase beta.
3. The patient must have a documented history of an inadequate response with ERT with agalsidase alfa.
4. The patient must not have any contraindication for Fabrazyme therapy, including known hypersensitivity to the product or to any of its components.
5. The patient’s estimated glomerular filtration rate (eGFR) must be greater than or equal to 30 mL/min/1.73m2.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

58468-0040-01

Fabrazyme (GENZYME CORPORATION)

35 MG


58468-0041-01

Fabrazyme (GENZYME CORPORATION)

5 MG



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