NC Medicaid will now cover, effective for dates of service from July 26, 2024, and limited to FDA authorization for importation, the following presentations of imported benzathine benzylpenicillin tetrahydrate (Lentocilin) for use in outpatient medical drug claims when billed with HCPCS code J0561 - Injection, penicillin g benzathine, 100,000 units and at outpatient pharmacy (point-of-sale).
This new coverage is being added to address the ongoing shortages of Bicillin® L-A (penicillin G benzathine injectable suspension). NC Medicaid coverage of imported Lentocilin will end when the shortage has resolved.
The FDA has provided Lentocilin distribution and administration information in a letter to healthcare providers. Please note that the preparation and administration of Lentocilin and the contraindications for prescribing differ from those for Bicillin® L-A and imported Extencilline. Additionally, the volume of Lentocilin 1,200,000 units after reconstitution is around 4 mL compared to 2 mL for Bicillin L-A 1,200,000 units. Benzathine benzylpenicillin is another name for Penicillin G benzathine. Lentocilin will only be available by prescription in the United States.
Strength/Package Sizes: NC Medicaid covers approved lots and batches only.
- 1,200,000 units: Lentocilin S, (Benzathine Benzylpenicillin Tetrahydrate) Powder and diluent for suspension for injection, 1,200,000 units
This coverage for Lentocilin follows other actions by the NC Department of Health and Human Services (NCDHHS), including joining other southeastern states in partnership to combat the surge in congenital syphilis infections, establishing a provider resource webpage, increasing Bicillin® L-A rates, covering imported Extencilline in NC Medicaid and a public education campaign.
For Medicaid Billing
- For Medical Claims:
- Providers must bill the product with HCPCS code: J0561 - Injection, penicillin g benzathine, 100,000 units.
- One Medicaid unit of coverage is 100,000 units.
- Providers must bill 11-digit NDCs and appropriate NDC units and appropriate NDC units. The NDCs is 84383-0110-01
- 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.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
- For pharmacy claims, Lentocilin is payable for dates of service effective July 26, 2024. Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are 84383-0110-01. Please refer to Outpatient Pharmacy Clinical Coverage Policy 9 for additional information
Contact
NCTracks Call Center: 800-688-6696
NC Managed Care health plans