Does J2267 require prior authorization?

No, J2267 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J2267?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J2267`, Injection, mirikizumab-mrkz, 1 mg

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Before starting therapy, screen for TB, check baseline liver enzymes and bilirubin, and ensure age-appropriate vaccinations per guidelines.
Prescribed by or in consultation with a gastroenterologist; and Authorization will be issued for 3 induction doses

Key Coverage Criteria

Indication: Ulcerative colitis - diagnosis of moderately to severely active UC with three IV induction doses per FDA-labeled UC dosing, not in combination with another systemic targeted immunomodulator, authorization for 3 induction doses.
Covered when hospital outpatient facility infusion services for specialty medications and IVIG/SCIG therapy are considered medically necessary and the member meets the specific clinical criteria described in the policy.
Ulcerative colitis in adults 18+ with moderate-to-severe disease who have not adequately responded to, lost response to, or could not tolerate corticosteroids, 6-mercaptopurine, azathioprine, biologics (TNF blockers or vedolizumab), or tofacitinib, and must have no active infection.
Crohn’s disease in adults 18+ with moderate-to-severe disease who have not adequately responded to, lost response to, or tolerated corticosteroids, immunomodulators (azathioprine, 6-mercaptopurine, methotrexate), and/or biologics (TNF blockers, integrin receptor antagonists); AND must have no active infection.
Medically necessary: Intravenous mirikizumab-mrkz (Omvoh) for adults (≥18) with moderately to severely active UC or Crohn’s disease who have had inadequate or intolerant response to standard therapies and with no active infection.
Ulcerative colitis in adults 18+ with moderate-to-severe disease who have not adequately responded to, lost response to, or could not tolerate corticosteroids, 6-mercaptopurine, azathioprine, biologics (TNF blockers or vedolizumab), or tofacitinib, and must have no active infection.

9 Active Policies

UHC-POL-omvoh, Omvoh (Mirikizumab-Mrkz)

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

BCBSIL-RX501.168, Mirikizumab-mrkz

BCBSMT-RX501.168, Mirikizumab-mrkz

BCBSNM-RX501.168, Mirikizumab-mrkz

BCBSOK-RX501.168, Mirikizumab-mrkz

UMR-POL-UMR-omvoh, Omvoh (Mirikizumab-Mrkz)

UMR-POL-UMR-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

SUREST-POL-SUREST-omvoh, Omvoh (Mirikizumab-Mrkz)

`J2267`, Injection, mirikizumab-mrkz, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

J2267, Injection, mirikizumab-mrkz, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`J2267`, Injection, mirikizumab-mrkz, 1 mg