Gammaplex - CuraFi

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Gammaplex (IVIG)

Billing

Code: J1557

Description: Gammaplex injection

Unit: 0.5 g

Payment: $57.010

Pay quarter: Q4 2023

Dosage and Frequency

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$3,420.60

(ASP: $3,226.98, Margin: $193.62)

Code:

J1557

# Units to bill:

Prior Authorization

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

1. The patient must have an established diagnosis of primary immunodeficiency (PID) or chronic lymphocytic leukemia (CLL).
2. The patient must have failed to respond to standard therapies.
3. The patient must have laboratory evidence of a low immunoglobulin level.
4. The patient must have a documented history of frequent infections.
5. The patient must have a documented history of recurrent infections.
6. The patient must have a documented history of infections that were unresponsive to antibiotic therapy.
7. The patient must have a documented history of at least one serious infection in the past year.
8. The patient must not have any contraindications or other conditions that would make Gammaplex therapy unsafe or ineffective.
9. The patient must agree to comply with all instructions regarding Gammaplex use and monitoring.

Insurance prior auth guidelines:

Billable NDCs

64208-8234-02