Drug Alerts and Special Reports

Key reimbursement alerts for office-administered drugs — C-Code, J-Code, NDC, and NCCN alerts plus pricing updates, sent on behalf of pharma manufacturers.

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FDA Approved 01/03/2024

Permanent J-Code for BARHEMSYS® (amisulpride injection): Available January 1, 2024 - 12/20/2

Effective for claims on or after January 1, 2024: J0184 Injection, amisulpride, 1 mg HCPCS Code Information 1 : HCPCS Code J0184 HCPCS Code Descriptor Injection, amisulpride, 1 mg WAC per HCPCS Unit $9.00 NDC Information 2 : NDC Number Package Description WAC per Package 71390-0125-21 One single-dose vial containing 5 mg/2 mL of intravenous solution* $45.00 71390-0125-20 Bundle of 10 single-dose vials, each containing 5 mg/2 mL of intravenous solution $450.00 71390-0125-51 One single-dose vial containing 10 mg/4 mL of intravenous solution* $90.00 71390-0125-50 Bundle of 10 single-dose vials, each containing 10 mg/4 mL of intravenous solution $900.00 *Note: individual vial ordering is not available. For reimbursement questions, please contact: [email protected] . For additional information regarding Barhemsys, please contact your Key Account Manager or visit Barhemsys.com Indications Barhemsys is a selective dopamine-2 (D 2 ) and dopamine-3 (D 3 ) receptor antagonist…

C-Code 12/13/2023

Temporary C-Code for YCANTH® (cantharidin): C9164 - 12/13/23

Available January 1, 2024 Effective for claims on or after January 1, 2024: C9164 YCANTH™ (cantharidin) for topical solution, 0.7% YCANTH is indicated for the topical treatment of molluscum contagiosum in adult and pediatric patients 2 years of age and older. Please see accompanying Prescribing Information and Important Safety Information HCPCS Code Information: HCPCS Code: C9164 HCPCS Code Descriptor: Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)* NDC Codes: 71349-0070-01 71349-0070-06 71349-0070-12 WAC per HCPCS Unit: $685.00 *Each YCANTH single-use applicator contains 3.2 mg of cantharidin (0.7%). NDC Code Information: NDC Code Package Description WAC per Package WAC per HCPCS Unit 71349-0070-01 YCANTH 0.7% (Each ampule of YCANTH contains approximately 0.45 mL of 0.7% cantharidin solution. Each mL of YCANTH contains 7 mg cantharidin (0.7%)) Applicator (One carton in one package) $685.00 $685.00 71349-0070-06 YCANTH 0.7% (Each ampule of YCANTH…

Pricing 12/13/2023

Announcing a Price Change for Paragard® (intrauterine copper contraceptive) - 12/12/23

Paragard Customer, Effective January 1, 2024, the pricing of Paragard will change as outlined below. Please take a moment to update any of your reimbursement, billing, and ordering systems to reflect this change. PARAGARD Pricing and Coding Information: HCPCS Code Labeler 11 Digit NDC Price Effective Date Product Description WAC Estimated AWP J7300 COOPERSURGICAL 59365-5128-01 1/1/24 PARAGARD T380A 10 YEARS $1085 $1302 CooperSurgical is notifying all customers and business associates about this change, and we would appreciate your partnership in helping us ensure that all systems and locations involved with Paragard are updated with the new Paragard pricing. For any questions, contact CooperSurgical at 1.877.PARAGARD. Paragard is a registered trademark of CooperSurgical, Inc. © 2023 CooperSurgical, Inc. C-US-PAR-000444 December 2023.

12/05/2023

XACIATO™ for the treatment of Bacterial vaginosis - 12/5/23

Learn more about XACIATO Bacterial vaginosis (BV) can be embarrassing for patients. XACIATO TM (clindamycin phosphate) vaginal gel 2%, a single-dose treatment for BV in females 12 years of age and older, is available in pharmacies. BV affects as many as 21 million women in the United States. Many current treatments need to be used for multiple days. XACIATO treats BV in a single dose . • A single intravaginal dose at any time of day. • Thermosetting formulation for gradual release of clindamycin. 1 - XACIATO vaginal gel increases viscosity at body temperature and gradually releases clindamycin over time. a • Robust efficacy in both new and recurrent BV: - Significantly higher clinical cure at day 21-30 vs placebo in both subsets of patients with ≤3 episodes or >3 episodes (recurrent) of BV in the past 12 months. 2 Treatment difference: ≤3 episodes of BV in the past 12 months: 32.2%; 95% CI: 13.9, 50.4; P =0.001 (XACIATO: N=101, placebo: N=46). Recurrent BV: 46.9%; 95% CI: 10.1…

J-Code 11/30/2023

Permanent J-Code for RYSTIGGO® (rozanolixizumab-noli): Available January 1, 2024 - 11/30/23

Corrected WAC Pricing Effective for claims on or after January 1, 2024 1 : J9333 Injection, rozanolixizumab-noli, 1 mg RYSTIGGO (rozanolixizumab-noli) is the first and only FDA-approved targeted treatment for both anti-acetylcholine receptor (AChR) and anti-muscle-specific tyrosine kinase (MuSK) antibody-positive (Ab+) adult patients with generalized myasthenia gravis (gMG). 2 *Corrected WAC Pricing* HCPCS Code 1 J9333 HCPCS Code Descriptor 1 Injection, rozanolixizumab-noli, 1 mg NDC Codes 2 50474-980-79 50474-0980-79* Package Description 2 Each carton of RYSTIGGO contains one single-dose glass vial containing 280 mg/2 mL (140 mg/mL) WAC per HCPCS Unit 3 $21.61 WAC per Package 3 $6,050 ICD-10-CM Codes 4,† G70.00 Myasthenia gravis without (acute) exacerbation G70.01 Myasthenia gravis with (acute) exacerbation *For certain purposes, including the proper billing of drug products, an 11-digit NDC may be required. † These diagnosis codes are informational and not intended to be directive…

FDA Approved 11/14/2023

VABYSMO® (faricimab-svoa): New Indication Now Approved - 11/6/23

View in browser Important Safety Information Prescribing Information Now approved for your members with Macular Edema following Retinal Vein Occlusion (RVO): The first and only dual-pathway inhibitor in retinal disease 1-5 Please refer to the billing and coding information below, and ensure your systems and policies are updated accordingly. Sample Billing and Coding for Macular Edema following RVO TYPE CODE DESCRIPTION ICD-10-CM H34.8110 Central retinal vein occlusion, right eye, with macular edema H34.8120 Central retinal vein occlusion, left eye, with macular edema H34.8130 Central retinal vein occlusion, bilateral, with macular edema H34.8190 Central retinal vein occlusion, unspecified eye, with macular edema H34.8310 Tributary (branch) retinal vein occlusion, right eye, with macular edema H34.8320 Tributary (branch) retinal vein occlusion, left eye, with macular edema H34.8330 Tributary (branch) retinal vein occlusion, bilateral, with macular edema H34.8390 Tributary (branch)…

Biosimilar 10/10/2023

Samsung Bioepis Biosimilar Market Report 3rd Edition, Q4 2023 - 10/10/23

SAMSUNG BIOEPIS Biosimilar Market Report 3 rd Edition, Q4 2023 Download Here I. US Biosimilars Approval and Launch Status II. Biosimilar Price - Medical Benefit Oncology Supportive Care Immunology & Ophthalmology - Pharmacy Benefit Immunology and Endocrinology III. Biosimilar Market Dynamics - Biosimilar Market Adoption & Price Erosion - Market Share & Price Trends Oncology Supportive Care Immunology Endocrinology Ophthalmology IV. Biosimilars Deep Dive Download Here © 2023 Samsung Bioepis Co., Ltd. All Rights Reserved. 9/2023. BuyandBill.com SAMSUNG…

10/05/2023

Setmelanotide as a Protein replacement agent: USP Medicare Modeling Guidelines - 10/5/23

On September 29th, The United States Pharmacopeia (USP) issued the Medicare Modeling Guidelines (MMG) version 9.0 including setmelanotide as a Protein replacement agent Read the USP 9.0 Guidelines Updates to USP Medicare Modelling Guidelines include changes in therapeutic uses of covered Part D drugs and the additions of new covered Part D drugs. Anti-obesity agents are not included in the USP-MMG guidelines. The USP Medicare Model Guidelines (MMG) is an independent drug classification system designed for Centers for Medicare & Medicaid Services (CMS) Part D formulary submissions Being recognized as a “Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment” means that setmelanotide is not categorized as an anti-obesity agent by USP The members of the USP Council of Experts, the Healthcare Safety and Quality Expert Committee (HSQ EC) comprised of independent pharmacologists, clinical pharmacists, academicians, formulary specialists, providers, beneficiaries, drug…

FDA Approved 10/04/2023

Now Approved: VANFLYTA® (quizartinib) for FLT3-ITD AML - 10/3/23

Learn more about this new treatment option. Review the PI and Boxed WARNINGS. ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ The first and only FLT3 inhibitor to specifically target the FLT3-ITD mutation in acute myeloid leukemia VANFLYTA Package Information Strength Package NDC Code 17.7 mg 28‐count bottle 65597‑0504‑28 14‐count bottle 65597‑0504‑04 26.5 mg 28‐count bottle 65597‑0511‑28 14‐count bottle 65597‑0511‑04…

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