Description: Glassia injection
Unit: 10 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 60mg/kg IV every 1 week
Calculate drug reimbursement
(ASP: $2,452.98, Margin: $147.18)
# Units to bill:480
Prior auth criteria for Glassia may include but is not limited to:
1. The patient has been diagnosed with Alpha-1 Antitrypsin Deficiency (AATD).
2. The patient is at least 18 years old.
3. The patient has been prescribed Glassia by a licensed healthcare provider.
4. The patient has failed or is intolerant to currently available AATD treatments.
5. The patient has had genetic testing confirming the diagnosis of AATD.
6. The patient has had a pulmonary function test (PFT) confirming the diagnosis of AATD.
7. The patient has had an evaluation to assess the severity of the AATD.
8. The patient is not pregnant.
9. The patient has not had a recent exacerbation of lung disease.
10. The patient has no known allergies to Glassia or its components.
Insurance prior auth guidelines:
GLASSIA (TAKEDA PHARMACEUTICALS AMERICA, INC.)