Orencia - CuraFi

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Orencia (abatacept)

Billing

Code: J0129

Description: Abatacept injection

Unit: 10 mg

Payment: $42.700

Pay quarter: Q4 2023

Dosage and Frequency

Rheumatoid Arthritis

• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg

Induction:
• at weeks 0, 2, and 4

Maintenance:
• every 4 weeks

OR

• 125mg SQ every 1 week

Polyarticular Juvenile Idiopathic Arthritis

• 10mg/kg IV if patient weighs less than 75kg
• Follow dosage for Rheumatoid Arthritis if patient weighs greater than or equal to 75kg

Induction:
• at weeks 0, 2, and 4

Maintenance:
• every 4 weeks

OR

• 50mg every 1 week if patient weighs 10-25kg
• 87.5mg every 1 week if patient weighs 25-50kg
• 125mg every 1 week if patient weighs greater than 50kg

Psoriatic Arthritis (PsA)

• 500mg IV if patient weighs less than 60kg
• 750mg IV if patient weighs 60-100kg
• 1000mg IV if patient weighs greater than 100kg

Induction:
• at weeks 0, 2, and 4

Maintenance:
• every 4 weeks

OR

• 125mg SQ every 1 week

prophylaxis of acute graft versus host disease (aGVHD)

For patients aged 6 years or older
• 10mg/kg IV (not to exceed 1000mg) on day before transplantation, and days 5, 14, and 28 after transplantation

For patients aged 2-6 years
• 15mg/kg IV on day before transplantation
• 12mg/kg IV on days 5, 14, and 28 after transplantation

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$3,202.50

(ASP: $3,021.23, Margin: $181.27)

Code:

J0129

# Units to bill:

Prior Authorization

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

• Patient must have a diagnosis of active rheumatoid arthritis that has been confirmed by x-ray, MRI, or other appropriate clinical laboratory test.
• Patient must have an inadequate response to one or more disease-modifying anti-rheumatic drugs (DMARDs) or have a contraindication to or intolerance of DMARDs.
• Patient must have a high disease activity as measured by C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR).
• Patient must have a score of ? 6 on the American College of Rheumatology (ACR) 20 criteria.
• Patient must have evidence of joint destruction on x-ray.
• Patient must not have a history of tuberculosis (TB) or other serious infections.
• Patient must not have a history of hypersensitivity to abatacept or any of the components of the Orencia formulation.

Insurance prior auth guidelines:

Billable NDCs

00003-2187-10

Abatacept (BRISTOL-MYERS SQUIBB COMPANY)

250 MG

00003-2187-13

ORENCIA (BRISTOL-MYERS SQUIBB COMPANY)

250 MG