Effective with date of service Aug. 19, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover pozelimab-bbfg injection, for intravenous or subcutaneous use (Veopoz) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Strength/Package Size: Injection: 400 mg/2 mL (200 mg/mL) in a single-dose vial.
Pozelimab-bbfg injection, for intravenous or subcutaneous use, is indicated for the treatment of adult and pediatric patients 1 year of age and older with CD55-deficient protein-losing enteropathy (PLE), also known as CHAPLE disease.
Recommended Dose:
- Day 1 (loading dose): Administer a single 30 mg/kg dose by intravenous infusion after dilution.
- Day 8 and thereafter (maintenance dosage): Inject 10 mg/kg as a subcutaneous injection once weekly starting on Day 8.
- The maintenance dosage may be increased to 12 mg/kg once weekly if there is inadequate clinical response after at least three weekly doses (i.e., starting from Week 4).’
- The maximum maintenance dosage is 800 mg once weekly.
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis codes required for billing is: D84.1 - Defects in the complement system
- Providers must bill with HCPCS code: J3590 - Unclassified biologics
- One Medicaid unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $93.46154
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 61755-0014-00, 61755-0014-01
- 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 NC Medicaid'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 Sept. 20, 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