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INSIDE THIS ISSUE Code Updates: Large Price Changes HCPCS Code Update for Makena Subcutaneous Auto-Injector NDC Crosswalk update for HCPCS Code(s) J7060 and J7070 (Dextrose) NDC Crosswalk update for HCPCS Code J0461 Reminder – NEW HCPCS Q-Codes effective July 1, 2018 NEW HCPCS C-Codes for Hospital OPPS Billing effective July 1, 2018 Deleted HCPCS Code […]

Hereditary transthyretin (TTR)-mediated amyloidosis (hATTR) is an inherited and debilitating disease that is characterized by mutations in the TTR gene. These gene mutations can cause accumulation of abnormal amyloid proteins in body organs and tissue, leading to damage of these areas, such as the peripheral nerves. Peripheral, autonomic, or cardiomyopathy can result from this accumulation […]

There were a total of three new FDA drug approvals in June that we deemed specific to the specialty market. In addition, there were six supplemental drug approvals. The FDA had assigned six new products for review. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

RJ Health has a new white paper available for download. Automated Controls for Medical Drug Spend by RJ Health’s Chief Innovation Officer, George Herchenroether – Appropriate reimbursement for drugs covered by the medical benefit requires more data and structure than most medical claims or billing systems were originally intended to process. This applies even more […]

New Drug Overview: Pegfilgrastim-jmdb (Fulphila™) The first FDA approved biosimilar to Pegfilgrastim (Neulasta®) Generic Name Brand Name Manufacturer Approval Date Anticipated Availability Accelerated Review Pegfilgrastim-jmdb Fulphila™ Mylan GmbH June 4, 2018 In the coming weeks n/a Labeled Indication: Decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive […]

INSIDE THIS ISSUE Code Updates: Large Price Changes Reminder – NEW HCPCS Q-Codes effective July 1, 2018  CMS NEWS: April 1, 2018 NOC Pricing File Updated Drug Reimbursement Code Price Updates  Drugs/Devices: New Clinical and Billing Information New Webinar: Shedding Light on Medically Covered Specialty Drug Pricing Methods Let’s discuss Specialty Drug Pricing Methods… WAC. […]

Control your Medical Drug Spend.  Learn about medically covered specialty drug pricing methods.  Explore the differences between AWP, WAC, ASP, APC.  Discover NDC level pricing and Code level pricing. Webinar: Shedding Light on Medically Covered Specialty Drug Pricing Methods In this new ReimbursementCodes webinar, Shedding Light on Medically Covered Specialty Drug Pricing Methods, we will […]

May 2018 Specialty Drug FDA Actions In May there were a total of five new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were eight supplemental drug approvals. The FDA had assigned eight new products for review and assigned five potential specialty products with June 2018 PDUFA dates. […]

Migraine is a debilitating disorder that affects millions of people in the United States. Migraine has the ability to affect individuals in a way that deprives them of their normal, daily activities, and often results in pain, physical impairment, lost productivity, and increased financial cost. Fremanezumab (TEV-48125), developed by Teva Pharmaceutical Industries Ltd., is a […]

Mogamulizumab is a humanized monoclonal antibody being developed by Kyowa Hakko Kirin Co., Ltd. for the treatment of cutaneous and peripheral T-cell lymphomas, T-cell leukemia, and T-cell lymphomas. Mogamulizumab has shown promising efficacy in treating Cutaneous T-Cell Lymphoma (CTCL) in a phase III trial. The FDA granted mogamulizumab a Breakthrough Therapy Designation on August 25, […]