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Effective for claims on or after April 1, 2024:


BALFAXAR: J7165

BALFAXAR (prothrombin complex concentrate, human-lans) is a blood coagulation factor replacement product indicated for the urgent reversal of acquired coagulation factor deficiency induced by Vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with need for an urgent surgery/invasive procedure.



HCPCS Information:

Drug Name

HCPCS Code

HCPCS Code Descriptor

WAC per HCPCS Unit

BALFAXAR

J7165

Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity

$3.15


NDC Information:

NDC Code xxxxxxxxxx

Vial NDC

xxxxxxxxx

Description

WAC per Package

WAC per

HCPCS Unit

68982-0261-01

68982-0261-81

Lyophilized powder for reconstitution for intravenous use in a single-dose vial, provided in a nominal strength of 500 Factor IX units in 20 mL reconstitution volume

$3.15

$3.15

68982-0261-02

68982-0261-82

Lyophilized powder for reconstitution for intravenous use in a single-dose vial, provided in a nominal strength of 1000 Factor IX units in 40 mL reconstitution volume

$3.15

$3.15

For questions on billing, coding, and reimbursement, please contact 800-554-4440

Indications and Usage


BALFAXAR (prothrombin complex concentrate, human-lans) is a blood coagulation factor replacement product indicated for the urgent reversal of acquired coagulation factor deficiency induced by Vitamin K antagonist (VKA, e.g., warfarin) therapy in adult patients with need for an urgent surgery/invasive procedure

Important Safety Information

WARNING: ARTERIAL AND VENOUS THROMBOEMBOLIC COMPLICATIONS


Patients being treated with Vitamin K antagonists (VKA) therapy have underlying disease states that predispose them to thromboembolic events. Potential benefits of reversing VKA should be weighed against the potential risks of thromboembolic events, especially in patients with the history of a thromboembolic event. Resumption of anticoagulation should be carefully considered as soon as the risk of thromboembolic events outweighs the risk of acute bleeding. Both fatal and non-fatal arterial and venous thromboembolic complications have been reported with BALFAXAR in clinical trials and post marketing surveillance. Monitor patients receiving BALFAXAR for signs and symptoms of thromboembolic events. BALFAXAR may not be suitable in patients with thromboembolic events in the prior 3 months.


BALFAXAR is contraindicated in patients with known anaphylactic or severe systemic reactions to BALFAXAR or any of its components. BALFAXAR is also contraindicated in patients with a known allergy to heparin, a history of heparin-induced thrombocytopenia (HIT), and IgA deficient patients with known antibodies against IgA.


In clinical trials, the most frequent (≥3%) adverse reactions observed in subjects receiving BALFAXAR were procedural pain, wound complications, asthenia, anemia, dysuria, procedural vomiting, and catheter-site-related reaction.


BALFAXAR is derived from human plasma. The risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent and its variant (vCJD), cannot be completely eliminated.




Please click here for Full Prescribing Information, including BOXED WARNING.


To report suspected adverse reactions, contact Octapharma USA Inc. at 1-866-766-4860 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

©2023. Octapharms USA, Inc. All rights reserved.

Date of preparation: 12/2023. Job Code.