Description: Inj., patisiran, 0.1 mg
Unit: 0.1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 0.3mg/kg (max 30mg) IV every 3 weeks
Calculate drug reimbursement
(ASP: $22,680.23, Margin: $1,360.81)
# Units to bill:240
Prior auth criteria for Onpattro may include but is not limited to:
1. The patient has a confirmed diagnosis of polyneuropathy caused by hereditary transthyretin-mediated amyloidosis (hATTR) with onset at or before 65 years of age.
2. The patient is not a candidate for or has had an unsatisfactory response to available therapies.
3. The patient has provided written informed consent prior to the initiation of therapy.
4. The patient has been assessed and is deemed appropriate for treatment with Onpattro by a qualified physician with experience in the diagnosis and management of hATTR.
5. The patient has been evaluated for possible contraindications or significant drug interactions prior to treatment.
6. The patient has had a baseline ophthalmic examination, including Humphrey Visual Field 24-2 testing, performed and documented prior to the initiation of Onpattro therapy.
7. The patient has not been diagnosed with hereditary transthyretin amyloidosis with cardiomyopathy.
Insurance prior auth guidelines:
Onpattro (ALNYLAM PHARMACEUTICALS, INC.)