Specialty Drug Reimbursement – Newsletter – March 2019 – Volume 19, Issue 3


CMS News

Drug Reimbursement Code Price Updates


  • New Clinical and Billing Information

Software Updates

  • Prioritize your Code Level Pricing


Large Price Changes:

We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change.

Of the 35 AWP Drug Code Price changes this month, 9 (25%) were price decreases. The table in the Drug Reimbursement Code Price Updates section includes all AWP drug Code Price changes for this month. Please note:  These numbers represent AWP Code Price changes only. See below for examples of codes with significant price changes this month.



Price Decreases:

  • J2800 Injection, methocarbamol, up to 10 mL: Decrease of 26%
  • J0697 Injection, sterile cefuroxime sodium, per 750 mg: Decrease of 21%
  • J1450 Injection, ganirelix acetate, 250 mcg: Decrease of 11% 

Price Increases:

  • J9218 Leuprolide acetate, per 1 mg: Increase of 48%
  • J7614 Levalbuterol, inhalation solution, FDA-approved final product, non-compound, administered through DME, unit dose, 0.5 mg (Code reinstated effective 4/1/2008): Increase of 28%
  • J0735 Injection, fluconazole, 200 mg: Increase of 20%


CMS News:

Check back next month for any pertinent news or updates from CMS.


This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 35 Drug Codes that required a recalculation of their AWP Code Price. Log in to www.ReimbursementCodes.com to view the pricing updates for these codes.


A4216 B4160 J0207 J0780 J2469 J9530 Q9957
A9505 B4161 J0500 J0883 J2800 J8610 Q9963
A9604 C9488 J0596 J0884 J3110 J9218 Q9966
B4153 J0131 J0641 J1120 J7520 Q4122 Q9967
B4155 J0153 J0697 J1450 J7614 Q4183 S0132



As new drugs come to market we review them for possible inclusion in our database. When a new drug is added to the database, we develop detailed clinical and billing information for the drug if appropriate.

During the past month, our review identified one new drug that needed to be added to our database. Our review of existing drugs in our database with clinical and billing information already assigned identified three drugs that required updating.


ELZONRIS™ (tagraxofusp-erzs) injection, for intravenous use – by Stemline Therapeutics, Inc.


FARYDAK® (panobinostat) capsules, for oral use – by Novartis Pharmaceuticals Corporation

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

IBRANCE® (palbociclib) capsules, for oral use – by Pfizer Labs

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

REPATHA® (evolocumab) injection, for subcutaneous use – by Amgen Inc

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

STRENSIQ® (asfotase alfa) injection, for subcutaneous use- by Alexion Pharmaceuticals, Inc.

  • Indications & Usage, ICD-10CM Codes, and Dosage & Administration

VORAXAZE® (glucarpidase) For Injection, for intravenous use- by BTG International Inc.,

  • ICD-10CM Codes

BENLYSTA® (belimumab) Injection, for subcutaneous use– by GSK Group of Companies

  • Indications & Usage   


At RJ Health we work hard to make your experience using our data as enjoyable and easy as possible. One way you can get the information you are looking for, just by a click of the mouse, is by rearranging the pricing methodologies in the order that best suits your needs. This change can be made by clicking on Preferences under your name in the right-hand corner then click on the Methodology Order tab. In the tab you can adjust the order the pricing methodologies appears on the drug card screen just by clicking the orange arrows.


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