Vyvgart (efgartigimod)
Billing
Code: J9332
Description: Inj efgartigimod 2mg
Unit: 2 mg
Payment: $32.108
Pay quarter: Q4 2023
Dosage and Frequency
Generalized Myasthenia Gravis (gMG)
• 10mg/kg (max 1200mg) IV every 1 week for 4 weeks
• 10mg/kg (max 1200mg) IV every 1 week for 4 weeks
Calculate drug reimbursement
Total Reimbursement:
$12,843.20(ASP: $12,116.23, Margin: $726.97)
Code:
J9332# Units to bill:
400Prior Authorization
Prior auth criteria for Vyvgart may include but is not limited to:
1. Diagnosis of gMG as evidenced by positive results on one of the following diagnostic tests:
- Repetitive nerve stimulation
- Single-fiber electromyography
- Visual evoked potentials
2. Patient is at least 18 years old.
3. Patient is not pregnant or planning to become pregnant.
4. Patient has not received a prior course of Vyvgart.
5. Patient is not enrolled in a clinical trial for gMG.
6. Patient has not received any other treatments for gMG, such as immunosuppressive agents, anti-inflammatory drugs, or immunoglobulin, within the past 6 months.
7. Patient does not have any active malignancy.
8. Patient is not receiving any other investigational drug or device treatment.
Insurance prior auth guidelines:
Billable NDCs
73475-3041-05
EFGARTIGIMOD ALFA-FCAB (ARGENX)
400 MG
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