Soliris (eculizumab) — HCPCS J1299 + Q5151 / Q5152

CareCost Estimate · Billing Cheat Sheet

Alexion Pharmaceuticals (AstraZeneca Rare Disease) 300 mg / 30 mL SDV (10 mg/mL) IV q2wk maintenance Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J1299

2 mg = 1 unit (NOT 10 mg)

PNH dose

450 units

900 mg q2wk

Modifier

3 × 300 mg vials, no waste

Admin CPT

96365

~35-min IV — non-chemo

Medicare ASP+6%

$44.699

/2 mg · $20,114.55/900 mg

Codes & NDC — J1300 deactivated 3/31/25

Code	Product / Status
`J1300`	"Eculizumab, 10 mg" — DEACTIVATED 3/31/2025 (5× unit-math change)
`J1299`	Soliris (reference) — "Injection, eculizumab, 2 mg" (eff. 4/1/2025)
`Q5151`	Epysqli (eculizumab-aagh, Samsung Bioepis / Teva) — biosimilar, 2 mg/unit
`Q5152`	Bkemv (eculizumab-aeeb, Amgen) — interchangeable biosimilar, 2 mg/unit
Soliris NDC	`25682-001-01` (10) / `25682-0001-01` (11) — Alexion labeler 25682
Vial	300 mg eculizumab / 30 mL (10 mg/mL), preservative-free SDV
Indications	PNH, aHUS, gMG (anti-AChR+), NMOSD (anti-AQP4+ — J1299 only)

Dosing

PNH: 600 mg IV weekly × 4 wk (induction), then 900 mg wk 5, then 900 mg q2wk (450 units)
aHUS / gMG / NMOSD: 900 mg IV weekly × 4 wk, then 1,200 mg wk 5, then 1,200 mg q2wk (600 units)
Infusion ~35 min adults (≥40 kg)
Maintenance window: ±2 days from scheduled interval
Pediatric aHUS / gMG <40 kg: weight-band dosing per FDA label

SOLIRIS REMS — required

Same REMS framework applies to Bkemv (Q5152) and Epysqli (Q5151).

Phone: 1-888-765-4747 (via Alexion OneSource)
Web: UltSolREMS.com (shared portal w/ Ultomiris)
MenACWY + MenB per ACIP ≥2 wk before first dose (or antibacterial prophylaxis if therapy can't wait)
Prescriber + patient + dispensing pharmacy enrollment all required
REMS Patient Safety Card carried during therapy + 3 mo post-discontinuation

Administration & modifiers

Code	When
`96365`	Therapeutic IV, ~35 min (primary) — non-chemo
`96366`	Rarely needed (35-min infusion fits within first hour)
`96413`	NOT appropriate — eculizumab is non-chemo
JZ: 900 mg = 3 full 300 mg vials, no waste; 1,200 mg = 4 full vials. JW rare for whole-vial-multiple doses.

ICD-10

Code	Indication	Biosim OK?
`D59.5`	PNH (Marchiafava-Micheli)	Yes
`D59.32`	Hereditary HUS / aHUS	Yes
`D59.31`	Shiga-toxin HUS	NO — not eculizumab-eligible
`G70.00 / G70.01`	gMG (anti-AChR+)	Yes
`G36.0`	NMOSD (Devic's, anti-AQP4+)	NO — J1299 only

NMOSD (G36.0) is reference-only. Coding G36.0 under Q5151 or Q5152 triggers label-mismatch denial. Use J1299 or Ultomiris (J1303).

Payer requirements (May 2026)

Payer	PA	Biosimilar / Site preference
UnitedHealthcare	Yes	Many MA plans prefer Bkemv/Epysqli for new starts
Aetna (CPB)	Yes	Complement inhibitor PA; HOPD steerage active
Anthem / Carelon	Yes	CG-DRUG eculizumab/ravulizumab; biosimilar pref. for new starts
Cigna	Yes	HOPD steering common

Many payers prefer Ultomiris (J1303) for new starts — q8wk vs q2wk reduces ~20 infusions/year.

Medicare reimbursement (Q2 2026)

Code	ASP + 6% (per 2 mg unit)
`J1299` (Soliris)	$44.699
`Q5152` (Bkemv)	$41.789
`Q5151` (Epysqli)	$31.928 (~28% discount)
900 mg dose (J1299)	$20,114.55 (450 units)
1,200 mg dose (J1299)	$26,819.40 (600 units)

Site of care

Setting	POS	Notes
Physician office	11	35-min infusion fits cleanly
Ambulatory infusion suite	49	Preferred by UHC/Aetna/Cigna
Hospital outpatient	19/22	HOPD steering active — redirection at re-auth

Patient assistance — Alexion OneSource

Phone: 1-888-765-4747 (Alexion OneSource, M–F)
Email: OneSource@alexion.com
Soliris Co-Pay Program: commercial copay assistance (~500% FPL); excludes Medicare/Medicaid/federal
Independent foundation referral for Medicare patients (no manufacturer free-product PAP for federal-program patients)
Same hub serves Ultomiris, Strensiq, Voydeya

BOXED WARNING — SERIOUS MENINGOCOCCAL INFECTIONS: Life-threatening / fatal sepsis & meningitis (~1,000–2,000× baseline risk). MenACWY + MenB per ACIP ≥2 wk before first dose. SOLIRIS REMS enrollment mandatory. Same warning + REMS apply to Bkemv (Q5152) and Epysqli (Q5151).

Sources: FDA labels (Soliris BLA 125166, Bkemv 5/2024, Epysqli 7/2024), CMS HCPCS Apr 2025 update (J1300 term), CMS ASP Q2 2026, UHC/Aetna/Carelon/Cigna eculizumab policies, Alexion OneSource, AAPC. carecostestimate.com/drugs/soliris