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Saphnelo (anifrolumab)


Billing

Code: J0491

Description: Inj anifrolumab-fnia 1mg

Unit: 1 mg

Payment: $16.595

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Systemic Lupus Erythematosus (SLE)

• 300mg IV every 4 weeks

Calculate drug reimbursement


Total Reimbursement:

$4,978.50

(ASP: $4,696.70, Margin: $281.80)


Code:

J0491

# Units to bill:

300

Prior Authorization

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


1. Diagnosis of Systemic Lupus Erythematosus (SLE) based on the American College of Rheumatology criteria.

2. Patient must be at least 18 years of age.

3. Patient has not responded adequately to other treatments for SLE, including but not limited to immunosuppressive medicines, antimalarial medicines, and/or NSAIDs.

4. Patient does not have an active infection or an uncontrolled medical condition.

5. Patient does not have an allergy or intolerance to Saphnelo or any of its components.

6. Patient has not had a history of organ transplantation.

7. Patient has not had an allergic reaction to biologic therapies.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

00310-3040-00

Saphnelo (ASTRAZENECA)

300 mg



Resources

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