Effective with date of service Aug. 15, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover elranatamab-bcmm injection, for subcutaneous use (Elrexfio) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Strength/Package Sizes:
Injection:
- 76 mg/1.9 mL (40 mg/mL) in a single-dose vial.
- 44 mg/1.1 mL (40 mg/mL) in a single-dose vial.
Elranatamab-bcmm injection, for subcutaneous use, is indicated for the treatment of adult patients age 18 and over with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
Recommended Dose:
Step-up Dosing Schedule:
- Day 1: 12 mg
- Day 4: 32 mg
- Day 8: 76 mg
Weekly Dosing Schedule:
- One week after first treatment dose and weekly thereafter through week 24: 76 mg
Biweekly (Every Two Weeks) Dosing Schedule:
- Week 25 and every two weeks thereafter: 76 mg
NOTE: For responders only week 25 onward
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis codes required for billing are:
- C90.00 - Multiple myeloma not having achieved remission;
- C90.02 - Multiple myeloma in relapse
- Providers must bill with HCPCS code: J9999 - Not otherwise classified, antineoplastic drugs
- One Medicaid unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $185.45755
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 00069-2522-02, 00069-4494-02
- 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. 18, 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