Back to drug list

Truxima (rituximab-abbs)


Billing

Code: Q5115

Description: Inj truxima 10 mg

Unit: 10 mg

Payment: $37.626

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Rheumatoid Arthritis (RA)

• 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:

100

Prior 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:

Aetna

United Healthcare

Anthem

Cigna


Billable NDCs

63459-0103-10

Truxima (CEPHALON INC.)

100 MG


63459-0104-50

Truxima (CEPHALON INC.)

500 MG



Resources

Drug Enrollment Form

Website