Rituxan - CuraFi

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Rituxan (rituximab)

Billing

Code: J9312

Description: Inj., rituximab, 10 mg

Unit: 10 mg

Payment: $80.192

Pay quarter: Q4 2023

Dosage and Frequency

Rheumatoid Arthritis (RA)

• Two 1000mg IV doses separated by 2 weeks, every 6 months

Calculate drug reimbursement

Patient dosage

Patient insurance

Total Reimbursement:

$8,019.20

(ASP: $7,565.28, Margin: $453.92)

Code:

J9312

# Units to bill:

100

Prior Authorization

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

1. Rituximab must be used for the treatment of a diagnosed, documented B-cell NHL, CLL, or FL that has failed to respond to, or is contraindicated or not tolerated to, other therapies.

2. Patient must be 12 years of age or older.

3. The patient must have adequate organ function as demonstrated by laboratory values as specified below:

• Absolute neutrophil count > 1,000/mm3

• Platelet count > 50,000/mm3

• Total bilirubin < 1.5 x the upper limit of normal (ULN)

• Creatinine < 1.5 x ULN

• AST/ALT < 2.5 x ULN

4. The patient must not have had a prior response or have been previously treated with rituximab.

5. The patient must not be pregnant or breastfeeding.

6. The patient must not have any active infections requiring treatment.

7. The patient must not have any known hypersensitivity to murine proteins.

Insurance prior auth guidelines:

Billable NDCs

50242-0051-10

Rituxan (GENENTECH, INC.)

1000 MG

50242-0051-21

Rituxan (GENENTECH, INC.)

100 MG