INSIDE THIS ISSUE
- 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 55 AWP Drug Code Price changes this month, 18 (33%) 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.
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- J3246 Injection, tirofiban HCl, 0.25 mg, 75%
- Q0166 Granisetron hydrochloride, 1 mg oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 24-hour dosage regimen – see also S0091, 54%
- S0091 Granisetron hydrochloride, 1 mg (for circumstances falling under the Medicare statute, use Q0166), 54%
- J2274 Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg, 42%
- S0109 Methadone, oral, 5 mg, 24%
- Q4117 Hyalomatrix, per square centimeter (Code Price is based on Median Pricing Methodology), 11%
Check back next month for any pertinent news or updates from CMS.
Drug Reimbursement Code Price Updates:
This month, during our review of the 3079 Reimbursement HCPCS/CPT® Codes in our system, we identified 55 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.
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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 three new drugs which needed to be added to our database and four drugs that required updating.
PEMAZYRE™ (pemigatinib) tablets, for oral use-by Incyte Corporation
TRODELVY™ (sacituzumab govitecan-hziy) for injection, for intravenous use-by Immunomedics, Inc.
TUKYSA™ (tucatinib) tablets, for oral use-by Seattle Genetics, Inc.
AKOVAZ™ (ephedrine sulfate injection, USP) for intravenous use-by Avadel Legacy Pharmaceuticals, LLC
DEFITELIO® (defibrotide sodium) injection, for intravenous use-by Jazz Pharmaceuticals, Inc
REBLOZYL® (luspatercept-aamt) for injection, for subcutaneous use-by Celgene Corporation
VERZENIO® (abemaciclib) tablets, for oral use-by Eli Lilly and Company
Our tools and data:
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