Truxima (rituximab-abbs)
Billing
Code: Q5115
Description: Inj truxima 10 mg
Unit: 10 mg
Payment: $37.626
Pay quarter: Q4 2023
Dosage and Frequency
Rheumatoid Arthritis (RA)
• Two 1000mg IV doses separated by 2 weeks, every 6 months
• Two 1000mg IV doses separated by 2 weeks, every 6 months
Calculate drug reimbursement
Total Reimbursement:
$3,762.60(ASP: $3,549.62, Margin: $212.98)
Code:
Q5115# Units to bill:
100Prior Authorization
Prior auth criteria for Truxima may include but is not limited to:
1. The patient has a diagnosis of chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), follicular lymphoma, or diffuse large B-cell lymphoma (DLBCL).
2. The patient has failed or is intolerant to at least two prior lines of systemic therapy.
3. The patient has no other clinically significant active malignancy.
4. The patient has not received previous treatment with a CD20-directed therapy.
5. The patient has adequate organ function as evidenced by the following laboratory values:
- Absolute neutrophil count (ANC) > 500/mm3
- Platelet count > 75,000/mm3
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < 5 times upper limit of normal
- Total bilirubin < 2.0 mg/dL
6. The patient has adequate laboratory values for tumor lysis syndrome as evidenced by the following laboratory values:
- Uric acid < 8.0 mg/dL
- Potassium > 3.5 mEq/L
- Phosphorus > 2.5 mg
Insurance prior auth guidelines:
Billable NDCs
63459-0103-10
Truxima (CEPHALON INC.)
100 MG
63459-0104-50
Truxima (CEPHALON INC.)
500 MG
Resources