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Tysabri (natalizumab)


Billing

Code: J2323

Description: Natalizumab injection

Unit: 1 mg

Payment: $24.600

Pay quarter: Q4 2023


Medicare history

Dosage and Frequency

Multiple Sclerosis (MS)
Crohn's Disease (CD)

• 300mg IV every 4 weeks

Calculate drug reimbursement


Total Reimbursement:

$7,380.00

(ASP: $6,962.26, Margin: $417.74)


Code:

J2323

# Units to bill:

300

Prior Authorization

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


1) Patient is 18 years of age or older.

2) Patient has a confirmed diagnosis of relapsing remitting multiple sclerosis (RRMS) as defined by McDonald criteria.

3) Patient has had an inadequate response to, or is unable to tolerate, an alternate disease-modifying therapy for RRMS.

4) Patient does not have progressive multifocal leukoencephalopathy (PML).

5) Patient does not have any active infection or history of recurrent infection.

6) Patient is negative for anti-JC virus antibody.

7) Patient is not pregnant or breastfeeding.

8) Patient has not had a positive test result for hepatitis B virus surface antigen (HBsAg) or human immunodeficiency virus (HIV).

9) Patient has not had a demyelinating event within one month prior to initiation of Tysabri therapy.

10) Patient is enrolled in and compliant with the Tysabri Outcome Survey (TOS) and has agreed to comply with all of its requirements.


Insurance prior auth guidelines:

United Healthcare

Anthem

Cigna

Aetna


Billable NDCs

64406-0008-01

TYSABRI (BIOGEN)

300 MG



Resources

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