Ultomiris (ravulizumab-cwvz) — HCPCS J1303
CareCost Estimate · Billing Cheat Sheet
Alexion Pharmaceuticals (AstraZeneca Rare Disease)
100 mg/mL IV vials (300 mg, 1,100 mg) + SC OnBody cartridge
q8wk IV maintenance
Reviewed: May 2, 2026
ASP: Q2 2026
PNH maint dose
330 units
3,300 mg q8wk (60–<100 kg)
Modifier
JZ / JW
JW common (partial-vial waste)
Admin CPT
96365 + 96366
~30–45 min maint · non-chemo
Medicare ASP+6%
$223.675
/10 mg · $73,812.75/3,300 mg
Codes & NDC
| HCPCS | J1303 — "Injection, ravulizumab-cwvz, 10 mg" (permanent, eff. 10/1/2019) |
|---|
| NDC (300 mg) | 25682-022-01 / 25682-025-01 (300 mg/3 mL, 100 mg/mL) |
|---|
| NDC (1,100 mg) | 25682-028-01 (1,100 mg/11 mL, 100 mg/mL) |
|---|
| SC cartridge | 25682-031-xx — OnBody Injector 245 mg/3.5 mL (adult PNH only) |
|---|
| Reference | Soliris (eculizumab, J1299) q2wk; biosimilars Bkemv (Q5152), Epysqli (Q5151) |
|---|
| Benefit | Medical (provider buy-and-bill) for IV; SC OnBody often pharmacy benefit |
|---|
Dosing — weight-banded IV (adult PNH/aHUS)
| Weight | Loading (Day 1) | Maint. (Day 15, q8wk) |
|---|
| 40 to <60 kg | 2,400 mg | 3,000 mg |
| 60 to <100 kg | 2,700 mg | 3,300 mg |
| ≥100 kg | 3,000 mg | 3,600 mg |
- gMG / NMOSD (≥40 kg): identical weight-band schedule
- Maintenance window ±7 days (except first maint at Day 15)
- 1 unit = 10 mg — divide mg by 10 for J1303 units
- Year-1 typical (75 kg PNH): 1 load + 7 maint = ~2,250 J1303 units
- SC OnBody: 490 mg SC weekly via 2 cartridges (adult PNH only, FDA 3/2024)
ULTOMIRIS REMS — required
Separate enrollment from Soliris REMS — shared UltSolREMS.com portal but per-drug certification.
- Phone: 1-888-765-4747 (Alexion / UltSol REMS)
- Web: UltSolREMS.com
- MenACWY + MenB per ACIP ≥2 wk before first dose (or antibacterial prophylaxis)
- REMS Patient Safety Card carried during therapy + 8 months post-discontinuation
- Prescriber + pharmacy + infusion site enrollment all required
Common error: using Soliris REMS cert for Ultomiris. Hard REMS violation → FDA notification + payer recoupment. Confirm separate ULTOMIRIS REMS enrollment.
Modifiers — JW common for J1303
| Dose | Vial mix | Waste | Mod |
|---|
| 2,400 mg | 2×1,100 + 1×300 | 100 mg | JZ + JW |
| 2,700 mg | 2×1,100 + 2×300 | 100 mg | JZ + JW |
| 3,000 mg | 10×300 (no waste) | 0 mg | JZ |
| 3,300 mg | 1×1,100 + 7×300 | 0 mg | JZ |
| 3,600 mg | 2×1,100 + 5×300 | 100 mg | JZ + JW |
JW reporting required and reimbursable when waste occurs. 100 mg waste = 10 JW units on a separate line. Failing to report JW is both compliance + revenue risk.
ICD-10
| Code | Indication |
|---|
D59.5 | PNH (Marchiafava-Micheli) — primary |
D59.32 | Hereditary HUS / aHUS |
D59.39 | Other HUS (commonly used for aHUS) |
D59.31 | Shiga-toxin HUS — verify; generally NOT an Ultomiris indication |
G70.00 / G70.01 | gMG (adults, anti-AChR+) |
G36.0 | NMOSD (Devic's, adults, anti-AQP4+) |
Bill the right ICD-10 for the indication. Using D59.5 (PNH) on a gMG claim triggers indication-mismatch denial.
Payer requirements (May 2026)
| Payer | PA | Preference / UM |
|---|
| UnitedHealthcare | Yes | Combined C5 inhibitor policy; Ultomiris preferred for new starts |
| Aetna (CPB) | Yes | Complement inhibitor PA; HOPD steerage |
| Anthem / Carelon | Yes | Drug.00086 (combined ravulizumab/eculizumab); Carelon UM |
| Cigna | Yes | Magellan Rx UM common |
Many payers prefer Ultomiris over Soliris for new starts — q8wk eliminates ~20 infusions/year vs q2wk Soliris.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $223.675 / 10 mg (eff. 4/1 – 6/30/2026) |
| 3,300 mg dose | $73,812.75 (330 units) |
| 3,000 mg dose | $67,102.50 (300 units) |
| 3,600 mg dose | $80,523.00 (360 units, +JW for 100 mg waste) |
| Year-1 (1 load + 7 maint) | ~$503K (75 kg PNH) |
Site of care
| Setting | POS | Notes |
|---|
| Physician office | 11 | ~30–45 min maint infusion fits |
| Ambulatory infusion suite | 49 | Common; loading dose ~1.7–2.4 hr |
| Hospital outpatient | 19/22 | UHC/Aetna disfavor — HOPD steerage |
| Patient home (SC) | 12 | OnBody Injector adult PNH only |
Patient assistance — Alexion OneSource
- Phone: 1-888-765-4747 (same hub as UltSol REMS)
- Email: OneSource@alexion.com
- OneSource Co-Pay Program: commercial copay assistance; excludes Medicare/Medicaid/VA/TRICARE per federal anti-kickback rules
- OneSource PAP: free product for eligible uninsured / underinsured
- Independent foundation referral for Medicare patients (no manufacturer free-product PAP for federal-program patients)
BOXED WARNING — SERIOUS MENINGOCOCCAL INFECTIONS: Life-threatening / fatal sepsis & meningitis. MenACWY + MenB ≥2 wk before first dose. ULTOMIRIS REMS enrollment mandatory (separate from Soliris). Surveillance + REMS card for 8 months after last dose.