INSIDE THIS ISSUE
- Retroactive Pricing Issued for Q2043
- New Clinical and Billing Information
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 52 AWP Drug Code Price changes this month, 21 (40%) 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.
LOOK UP PRICES NOW:
- J0282 Injection, amiodarone hydrochloride, 30 mg, 6%
- J9025 Injection, azacitidine, 1 mg, 4%
- J9171 Injection, docetaxel, 1 mg, 3%
- J7626 Budesonide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.5 mg, 85%
- Q4158 Kerecis Omega3, per square centimeter (Code Price is based on Median Pricing Methodology),167%
- A4455 Adhesive remover or solvent (for tape, cement or other adhesive), per oz., 152%
Check back next month for any pertinent news or updates from CMS.
Retroactive Pricing Issued for Q2043
RJ Health is issuing retroactive pricing data for Q2043 – Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion (Code Price is per 250 mL) dating back to November 2019. Our data reflects this update in both November 2019 and March 2020 pricing records. Please update your systems accordingly.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 52 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.
LOOK UP PRICES NOW:
Drugs/Devices: New/Updated Billing & Clinical Information
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 four new drugs which needed to be added to our database and five drugs that required updating.
PALFORZIA [Peanut (Arachis hypogaea) Allergen Powder-dnfp] Powder for oral administration – by Aimmune Therapeutics, Inc.
RUXIENCE™ (rituximab-pvvr) injection, for intravenous use – by Pfizer
TAZVERIKTM (tazemetostat) tablets, for oral use – by Epizyme, Inc.
TEPEZZA (teprotumumab-trbw) for injection, for intravenous use – by Horizon Therapeutics Ireland DAC
COSENTYX® (secukinumab) for injection, for subcutaneous use – by Novartis Pharmaceuticals Corp.
LYNPARZA® (olaparib) tablets, for oral use – by AstraZeneca Pharmaceuticals LP
OVIDREL® (choriogonadotropin alfa for injection) for subcutaneous use – by Serono, Inc.
UNITUXIN™ (dinutuximab) injection, for intravenous use – by United Therapeutics Corp.
GIAPREZA™ (angiotensin II) Injection for Intravenous Infusion – by La Jolla Pharmaceutical Company
Our tools and data:
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