Alexion Pharmaceuticals

ULTOMIRIS

ASP | WAC | AWP at the HCPCS Unit

Manufacturer:

Alexion Pharmaceuticals

Ultomiris HCPCS:

J1303

HCPCS Code Descriptor:

Injection, ravulizumab-cwvz, 10 mg

Category:

J Code

Ultomiris NDCs:

25682-0028-01, 25682-0025-01, 25682-0022-01

Primary Type:

Immunology

Generic/Specialty Status:

Single-Source

Package Type:

Vial

Route of Administration:

Intravenous

Ultomiris CPT Codes:

Potential CPT administration codes for Ultomiris can be found at the following link.

Potential NDC Listing Errors:

Our team has identified potential listing errors/discrepancies with the following NDCs:

25682-0022-01

About Ultomiris:

ULTOMIRIS is an Immunology drug manufactured by Alexion Pharmaceuticals and administered via the Intravenous route of administration. The J Code: J1303 is aligned to the drug ULTOMIRIS.

Ultomiris is belongs to a class of drugs known as monoclonal antibodies. This drug works by inhibiting the C5 protein in the terminal complement cascade of the patient’s immune system. Ultomiris is a branded drug manufactured by Alexion Pharmaceuticals. Prior to its J Code assignment (J1303) in October 2019, Ultomiris was aligned to the C Code: C9052. Patient assistance programs can for Ultomiris can be found through Alexion’s OneSource.

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J1303 Added Date:

October 1, 2019

J1303 Effective Date:

October 1, 2019

J1303 Termination Date:

HCPCS Active

We have not yet identified a manufacturer source of Ultomiris billing and coding information.
Ultomiris patient assistance information can be found through Alexion OneSource at the URL: https://alexiononesource.com/
ULTOMIRIS prescribing information can be found at the link below:
Information regarding ULTOMIRIS’s side effects can be found at MedlinePlus