Description: Canakinumab injection
Unit: 1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 150mg SQ every 8 weeks if patient weighs more than 40kg
• 2mg/kg SQ every 8 weeks if patient weighs between 15-40kg
Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD)
Familial Mediterranean Fever (FMF)
• 2mg/kg SQ every 4 weeks if patient weighs 40kg or below
• 150mg SQ every 4 weeks if patient weighs more than 40kg
• 4mg/kg (not to exceed 300mg) SQ every 4 weeks
Calculate drug reimbursement
(ASP: $17,271.93, Margin: $1,036.32)
# Units to bill:150
Prior auth criteria for Ilaris may include but is not limited to:
1. The patient must have a diagnosis of Cryopyrin-Associated Periodic Syndrome (CAPS).
2. The patient must have a diagnosis of Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS).
3. The patient must have a diagnosis of Familial Cold Autoinflammatory Syndrome (FCAS) or Muckle-Wells Syndrome (MWS).
4. The patient must have had an inadequate response or intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs).
5. The patient must have failed at least one conventional disease-modifying antirheumatic drug (DMARD) therapy.
6. The patient must have an elevated C-reactive protein (CRP) or SAA level.
7. The patient must not be pregnant or lactating.
8. The patient must not have had any prior serious reactions or hypersensitivity reactions to Ilaris.
Insurance prior auth guidelines:
ILARIS (NOVARTIS PHARMACEUTICALS CORPORATION)