Happy National Pharmacy Week
The entire month of October is National Pharmacists Month. However, the week of October 21st through the 27th is National Pharmacy Week. According to ASHP, formerly the American Society of Hospital Pharmacists, this week “acknowledges the invaluable contributions that pharmacists and technicians make to patient care in hospitals, ambulatory care clinics, and other healthcare settings.” MMP could not agree more and would like to recognize the hard work, knowledge and collaborative spirit that Pharmacists and Technicians bring to the healthcare team in the hospital setting. In keeping with Pharmacy Week, this article highlights drugs approved as New Technologies available for Add-On Payments in the CMS 2019 Fiscal Year that started October 1st.
Drugs that Continue to be Eligible for New-Technology Add-On Payments in FY 2019
DEFITELIO® (defibrotide sodium)
Indication for Usage: DEFITELIO® is indicated for the treatment of adult and pediatric patients diagnosed with hepatic veno-occlusive disease (VOD) with evidence of multi-organ dysfunction.
- Maximum Add-On Payment: $80,500
- ICD-10-PCS Procedure Codes: XW03392 or XW04392
- Link to Drug Manufacturer website: https://defitelio.com
Indication for Usage: ZINPLAVA™ is indicated to reduce the recurrence of Clostridium difficile infection (CDI) in patients 18 years or older who are receiving antibacterial drug treatment and are at high risk of CDI recurrence.
- Maximum Add-On Payment: $1,900
- ICD-10-PCS Procedure Codes: XW033A3 or XW043A3
- Link to Drug Manufacturer website: https://www.merckconnect.com/zinplava
Indications for Usage: STELARA® is indicated to treat adult patients with moderate to severe active Crohn’s disease who have failed or were intolerant to treatment using immunomodulators or corticosteroids, but never failed a tumor necrosis factor (TNF) blocker, or failed or were intolerant to treatment using one or more TNF blockers.
- Maximum Add-On Payment: $2,400
- ICD-10-PCS Procedure Code: XW033F3
- Link to Drug Manufacturer website: https://www.stelarainfo.com
New Drugs Approved for New-Technology Add-On Payment in FY 2019
Indications for Usage: VYXEOS™ is indicated for the treatment of adults with newly diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC)
- Maximum Add-On Payment: $36,425
- ICD-10-PCS Procedure Codes: XW033B3 or XW043B3
- Link to Drug Manufacturer website: https://vyxeos.com
Indication for Usage: GIAPREZA™ is the first and only FDA-approved synthetic formulation of human angiotensin II treatment that activates the Renin-angiotensin- aldosterone system (RAAS) to increase blood pressure in adults with septic or distributive shock.
- Maximum Add-On Payment: $1,500
- ICD-10-PCS Procedure Codes: XW033H4 or XW043H4
- Link to Drug Manufacturer website: https://www.giapreza.com/about-giapreza/
ANDEXXA® (Coagulation Factor Xa (Recombinant), Inactivated-zhzo)
Indications for Usage: ANDEXXA™ is indicated for use in patients being treated specifically with rivaroxaban (Xarelto®) or apixaban (Eliquis®), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.
- Maximum Add-On Payment: $14,062.50
- ICD-10-PCS Procedure Codes: XW03372 or XW04372
- Link to Drug Manufacturer website: https://www.andexxa.com/
VABOMERE™ (meropenem and vaborbactam)
Indication for Usage: VABOMERE™ is indicated for the treatment of patients 18 years or older with complicated urinary tract infections (cUTI) including pyelonephritis caused by the following susceptible microorganisms: Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae species complex.
- Maximum Add-On Payment:
- NDC Codes: NDC of 70842012001 or 65293000901
- Note: See a related MMP article to read more about the use of the National Drug Code instead of ICD-10-PCS Procedure Codes for this drug.
- Link to Drug Manufacturer website: http://www.vabomere.com/
Indication for Usage: ZEMDRI™ is indicated for the treatment of patients 18 years or older diagnosed with cUTI, including pyelonephritis caused by the following susceptible microorganisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterobacter cloacae.
- Maximum Add-on Payment: $2,722.50
- ICD-10-PCS Procedure Codes: XW033G4 or XW043G4
- Link to Drug Manufacturer website: https://www.zemdri.com/resources
Again, Happy Pharmacy Week!
Article by Beth Cobb
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.