Payment: Claims for J2326 must be manually adjudicated
Pay quarter: N/A
Dosage and Frequency
• 12mg intrathecally every 2 weeks for 3 doses
• 12mg intrathecally 30 days after the third dose
• 12mg intrathecally every 4 months
Calculate drug reimbursement
(ASP: N/A, Margin: N/A)
# Units to bill:N/A
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: