Back to drug list

Oxlumo (lumasiran)


Billing

Code: J0224

Description: Inj. lumasiran, 0.5 mg

Unit: 0.5 mg

Payment: $319.496

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Primary Hyperoxaluria Type 1 (PH1)

Loading dose:
• 6mg/kg SQ every 1 month for 3 doses if patient weighs less than 20kg
• 3mg/kg SQ every 1 month for 3 doses if patient weighs 20kg or above

Maintenance:
• 3mg/kg SQ every 1 month if patient weighs less than 10kg
• 6mg/kg SQ every 3 months if patient weighs 10kg to less than 20kg
• 3mg/kg SQ every 3 months if patient weighs 20kg or above

Calculate drug reimbursement


Total Reimbursement:

$153,358.08

(ASP: $144,677.43, Margin: $8,680.65)


Code:

J0224

# Units to bill:

480

Prior Authorization

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


1. Oxlumo should be prescribed for patients 18 years of age and older who have been diagnosed with primary hyperoxaluria type 1 (PH1) by a healthcare professional.

2. The patient must have documented evidence of either a positive urinary oxalate/creatinine ratio greater than 0.8 mg/mg or oxalate stone formation.

3. The patient must not have had a prior allergic reaction to Oxlumo or any of its components.

4. The patient must have a body mass index (BMI) of 18.5 or greater.

5. The patient must not have any other medical conditions that would contraindicate the use of Oxlumo.

6. The patient must not be pregnant or breastfeeding.

7. The patient must have a serum creatinine level of less than 2.5 mg/dL.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

71336-1002-01

Oxlumo (ALNYLAM PHARMACEUTICALS, INC.)

94.5 MG



Resources

Website