Specialty Drug Reimbursement – Newsletter – May 2020 – Volume 20, Issue 5

INSIDE THIS ISSUE

Drug Reimbursement Code Price Updates

Drugs/Devices

• • New Clinical and Billing Information

CMS News

CODE UPDATES

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.

LOOK UP PRICES NOW:

CMS News:

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.

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 three new drugs which needed to be added to our database and four drugs that required updating.

New:

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.

Updated:

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

RJ Health is a drug data, application & analytics provider to the pharmacy reimbursement market, who brings scalability to specialty drug innovation. We focus on specialty drug innovation (new approvals and additional indications), as well as normalizing reimbursement for drug classifications that have market forces at-play (generics / biosimilars, rebates, and CMS policy). The company provides industry-standard pricing, coding, dosing, weight, age, and diagnosis data & analyses to pharmacy, market access, claims, billing, finance, and network management clientele. RJ Health ensures transparency between manufacturer, payor, provider, pharmacies and their respective solution vendors (PBMs, Payment Integrity, Revenue Cycle, EHR, etc…) – all licensees of RJ Health data. 

Our tools and data:

Assist in understanding drug pricing and healthcare reimbursement for drug claims

Enable organizations to look up and crosswalk NDCs and HCPCS codes – J codes, C codes and other

Assist in calculating drug dosage accurately and ensure claims are reimbursed properly based on unit requirements

Ensure claim accuracy and crosswalk drug codes

Help organizations make the best decisions for drug formularies

Combine clinical diagnosis and procedural coding matched to the right drug and dosage, as well as the most cost-efficient specialty drug price

View last month’s newsletter.

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