Cosentyx (secukinumab) — HCPCS J3247 (IV)

CareCost Estimate · Billing Cheat Sheet

Novartis Pharmaceuticals IV 125 mg/5 mL SDV · SC 75/150/300 mg PFS · pen IV q4wk (PsA/AS/nr-axSpA) · SC q4wk Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J3247

IV, 1 mg = 1 unit (eff. 7/1/2024)

Dose IV

300 units

300 mg max/dose · 1.75 mg/kg q4wk

Modifier

JZ / JW

Whole-vial JZ; JW for waste >0

Admin CPT

96365

IV 30-min, non-chemo

ASP+6%

$18.042

/mg · $5,412.60/300 mg dose

Codes & NDC

HCPCS	`J3247` — "Inj, secukinumab, intravenous, 1 mg" · permanent, eff. July 1, 2024 (legacy J3590 pre-7/1/24)
SC HCPCS	None. SC bills via NDC under pharmacy benefit. (Use `J3590` only if rare medical-benefit SC in-office.)
NDC IV	`0078-1168-61` — 125 mg/5 mL (25 mg/mL) SDV, Novartis labeler 0078
NDC SC	`0078-0639-41` Sensoready 2-pk (300 mg) · `0078-1070-68` UnoReady (300 mg) · 75 mg PFS · 150 mg PFS
Biosimilars	NONE approved Q2 2026. Patent estate runs through 2028+; substitution pressure low
Benefit	SC = pharmacy (~95%) · IV = medical buy-and-bill

Dosing

IV (J3247) — PsA / AS / nr-axSpA only:

Loading: 6 mg/kg IV × 1 (cap 300 mg/dose)
Maintenance: 1.75 mg/kg IV q4wk (cap 300 mg/dose)
1 mg = 1 unit; bill J3247 units = total mg administered (after weight calc, capped at 300)

SC (pharmacy NDC):

Indication	Loading	Maintenance
Plaque PsO (adult)	300 mg SC wk 0,1,2,3,4	300 mg q4wk
PsA / AS	150 or 300 mg SC wk 0–4	q4wk; 300 mg if concurrent PsO or TNFi failure
nr-axSpA	150 mg SC wk 0–4 (± loading)	150 mg q4wk (may up-titrate to 300)
HS	300 mg SC wk 0–4	300 mg q4wk; may up-titrate to q2wk
Pediatric PsO/JIA (≥50 kg)	150 mg wk 0–4	150 mg q4wk

Admin & modifiers

Code	When
`96365`	IV 30-min infusion (primary) — non-chemo
`96413`	NOT appropriate — secukinumab is non-chemo
`JZ`	Whole 125 mg vial used; no waste
`JW`	Discarded drug from SDV (e.g., 70 kg patient: bill 122.5 mg + JW 2.5 mg)

SDV waste common: 125 mg vials + weight-based dose (1.75 mg/kg) leave residual. Bill JW with discarded mg on separate line.

ICD-10 — SC vs IV (J3247)

ICD-10	Description	SC	IV
`L40.0`	Plaque psoriasis	Yes	NO
`L40.5x`	Psoriatic arthritis	Yes	Yes
`M45.x`	Ankylosing spondylitis	Yes	Yes
`M46.8x / M46.9`	nr-axSpA	Yes	Yes
`L73.2`	Hidradenitis suppurativa	Yes	NO
`L40.54`	Juvenile psoriatic arthropathy	Yes (≥2 yr)	Adults only

IV indication discipline: J3247 with L40.0 or L73.2 will deny — IV not approved for plaque PsO or HS as of Q2 2026.

Payer requirements (May 2026)

Payer	PA	Step / Notes
UnitedHealthcare	Yes	IL-17 step after TNFi (PsA/AS); concurrent PsO drives 300 mg dose
Aetna	Yes	Step therapy through preferred TNFi; specific ICD-10 required
BCBS / Carelon	Yes	Combined IL-17 policy; TB screen + indication-specific dosing
Medicare Part B	No NCD	Local MAC LCDs apply for J3247

No biosimilar to step through. PA focus: indication-specific ICD-10, TB screening, prior TNFi failure (PsA/AS/nr-axSpA pathways).

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6% (J3247)	$18.042 / mg (eff. 4/1–6/30/2026)
300 mg dose	$5,412.60 (300 × $18.042)
Annual (1 load + 12 maint × 140 mg avg @ 80 kg)	~$36,000 J3247 drug spend
SC (Part D)	WAC ~$6,800 / 300 mg dose; net varies by PBM

Site of care

Setting	POS	Notes
Patient home (SC)	12	Default for SC; pharmacy benefit, no medical claim
Physician office (IV)	11	30-min infusion fits cleanly
Ambulatory infusion suite	49	Common for IV maintenance
Hospital outpatient	19/22	UM disfavors

Patient assistance — Cosentyx Connect

Cosentyx Connect: 1-844-COSENTYX (1-844-267-3689) — benefits investigation, PA, copay, education
Co-Pay Program (commercial): as low as $0 copay; up to $16,000/yr drug + up to $1,950/yr ($150/infusion) IV admin support
Excludes: Medicare, Medicaid, TRICARE, VA, federal program patients
NPAF (Novartis Patient Assistance Foundation): free product for uninsured / gov-insured ≤500% FPL
Free Trial Offer: starter supply for new starts pending coverage
Web: cosentyx.com / cosentyxhcp.com

NO BOXED WARNING. Class warnings (W&P, not boxed): SERIOUS INFECTIONS, TB reactivation (TB screen required pre-initiation), IBD exacerbation (caution in IBD pts), hypersensitivity / anaphylaxis.

Sources: Novartis 2025 reimbursement guide, FDA label (BLA 125504), CMS ASP Q2 2026, FDA Purple Book (May 2026), AAPC, payer LCDs & commercial policies. carecostestimate.com/drugs/cosentyx