Effective with date of service July 27, 2020, the Medicaid and NC Health Choice programs cover inebilizumab-cdon injection, for intravenous use (Uplizna™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Uplizna™ is available as 100 mg/10 mL (10 mg/mL) solution in a single-dose vial and is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.
Recommended Dose (see full prescribing information for further detail):
- Initial dose: 300 mg intravenous infusion followed two weeks later by a second 300 mg intravenous infusion
- Subsequent doses (starting 6 months from the first infusion): single 300 mg intravenous infusion every 6 months
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code required for billing is: G36.0 - Neuromyelitis optica [Devic]
- Providers must bill with HCPCS code: J3590 - Unclassified biologics
- One Medicaid and NC Health Choice unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $471.60
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 72677-0551-01
- 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 Medicaid's website
- Providers shall bill their usual and customary charge for non-340B drugs
- PADP reimburses for drugs billed for Medicaid and Health Choice 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 reflective of their 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 Medicaid's PADP web page
Contact
NCTracks Contact Center: 800-688-6696