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Spinraza (nusinersen)


Billing

Code: J2326

Description: N/A

Unit: N/A

Payment: Claims for J2326 must be manually adjudicated

Pay quarter: N/A


Medicare history

Dosage and Frequency

Spinal Muscular Atrophy (SMA)

Loading dose:
• 12mg intrathecally every 2 weeks for 3 doses
• 12mg intrathecally 30 days after the third dose

Maintenance:
• 12mg intrathecally every 4 months

Calculate drug reimbursement


Total Reimbursement:

N/A

(ASP: N/A, Margin: N/A)


Code:

J2326

# Units to bill:

N/A

Prior Authorization

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


1. Patient must have a confirmed diagnosis of SMA.

2. Patient must be at least 2 months of age.

3. Patient must have two copies of the SMN2 gene.

4. Patient must have an ongoing need for the medication in order to maintain therapeutic benefit.

5. Patient must have a confirmed absence of anti-nusinersen antibodies.

6. Patient must not have any significant comorbidities or contraindications that would interfere with the safe administration of Spinraza.

7. Patient must have access to appropriate medical care, including regular monitoring and laboratory assessments.


Insurance prior auth guidelines:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

N/A


Resources

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