Effective with date of service May 26, 2023, the NC Medicaid programs cover risperidone extended-release injectable suspension, for subcutaneous use (Uzedy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Strength/Package Sizes: Extended-release injectable suspension: 50 mg/0.14 mL, 75 mg/0.21 mL, 100 mg/0.28 mL, 125 mg/0.35 mL, 150 mg/0.42 mL, 200 mg/0.56 mL, and 250 mg/0.7 mL single-dose prefilled syringes
Indicated for the treatment of schizophrenia in adults.
Recommended Dose: To start Uzedy, switch from oral daily risperidone. Initiate Uzedy, as either a once monthly injection or a once every two month injection, the day after the last dose of oral therapy. Neither a loading dose nor supplemental oral risperidone doses are recommended when switching.
Dosage recommendations for switching from daily oral Risperidone to Uzedy:
Option 1: Uzedy dosage once monthly
- Prior Therapy = 2 mg of oral risperidone per day: 50 mg
- Prior Therapy = 3 mg of oral risperidone per day: 75 mg
- Prior Therapy = 4 mg of oral risperidone per day: 100 mg
- Prior Therapy = 5 mg of oral risperidone per day: 125 mg
Option 2: Uzedy dosage once every two months
- Prior Therapy = 2 mg of oral risperidone per day: 100 mg
- Prior Therapy = 3 mg of oral risperidone per day: 150 mg
- Prior Therapy = 4 mg of oral risperidone per day: 200 mg
- Prior Therapy = 5 mg of oral risperidone per day: 250 mg
Patients can switch between doses of Uzedy once monthly and once every two months by administering the first dose of the new dosing regimen on the next scheduled date of administration in the original dosing regimen. Revise the dose administration schedule to reflect the change.
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis codes required for billing are:
- F20.0 - Paranoid schizophrenia;
- F20.1 - Disorganized schizophrenia;
- F20.2 - Catatonic schizophrenia;
- F20.3 - Undifferentiated schizophrenia;
- F20.5 - Residual schizophrenia;
- F20.89 - Other schizophrenia
- Providers must bill with HCPCS code: J3490 - Unclassified drugs
- One Medicaid unit of coverage is: 0.5 mg
- The maximum reimbursement rate per unit is: $13.30560
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 51759-0305-10, 51759-0410-10, 51759-0520-10, 51759-0630-10, 51759-0740-10, 51759-0850-10, 51759-0960-10
- The NDC units should be reported as "UN1"
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on DHB's website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PADP reimburses for drugs billed for Medicaid beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is their actual acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
ICD-10-CM Manual. American Medical Association, 2023 manual.
*Information current as of June 14, 2023, and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.
Contact
NCTracks Call Center, 800-688-6696