Author: CSRA
Effective with date of service Nov. 15, 2017, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover rolapitant injectable emulsion, for intravenous use (Varubi) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs. Varubi is available as an injectable emulsion: 166.5 mg/92.5 mL (1.8 mg/mL) of rolapitant in a single-dose ready-to-use vial.
Varubi is indicated in combination with other antiemetic agents in adults (greater than 18 years of age) for the prevention of delayed nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including, but not limited to, highly emetogenic chemotherapy. The recommended dose is 166.5 mg administered as an intravenous infusion over 30 minutes.
See full prescribing information for further details.
Medicaid and NCHC Billing
- ICD-10-CM diagnosis codes required for billing are:
- Z51.11 - Encounter for antineoplastic chemotherapy, * along with one or more of the following:
- R11.0 – Nausea
- R11.10 - Vomiting, unspecified
- R11.11 - Vomiting without nausea
- R11.12 - Projectile vomiting
- R11.13 - Vomiting of fecal matter
- R11.14 - Bilious vomiting
- R11.2 - Nausea with vomiting, unspecified
(*Required when given within 48 hours of moderately or highly emetogenic chemotherapy.)
- Providers must bill with HCPCS code J3490 - Unclassified drugs.
- One Medicaid unit of coverage is one vial. NCHC bills according to Medicaid units.
- The maximum reimbursement rate per unit is $318.60.
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NCD is 69656-0102-10.
- 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 PDP, refer to the Clinical Coverage Policy No. 1B, Physician Drug Program, Attachment A, H.7 on the Medicaid website.
- Providers shall bill their usual and customary charge for non-340-B drugs.
- PDP reimburses for drugs billed for Medicaid and NCHC beneficiaries by 340-B participating providers who have registered with the Office of Pharmacy Affairs (OPA) Providers billing for 340-B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340-B purchasing agreement by appending the “UD” modifier on the drug detail.
- The fee schedule for the PDP is available on the North Carolina Medicaid PDP web page
CSRA, 1-800-688-6696