Home  >  Resources  >  Blog

INSIDE THIS ISSUE Code Updates: Large Price Changes COMING SOON – New Q-Code Effective October 1, 2018 Drug Reimbursement Code Price Updates Drugs/Devices: New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for […]

Hairy cell leukemia (HCL) is a rare, slow-growing cancer of the blood in which the bone marrow produces too many abnormal B cells or lymphocytes. This compromises the bone marrow’s ability to produce healthy blood cells and platelets. Patients with HCL may experience enlargement of the spleen, increased susceptibility to life-threatening conditions such as infections […]

Hereditary angioedema (HAE) is a disease characterized by recurrent and debilitating attacks of angioedema, or severe swelling of the limbs, airway, face, or intestinal tract. HAE affects about one in 10,000 to 50,000 individuals worldwide and can have a significant impact on quality of life. There are currently six FDA-approved therapies available for individuals with […]

Generic Name Brand Name Manufacturer Approval Date Anticipated Availability Accelerated Review filgrastim-aafi Nivestym ™ Pfizer Inc. 07/20/2018 n/a n/a Labeled Indications Decrease the incidence of infection‚ as manifested by febrile neutropenia‚ in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever Reduce the time to neutrophil […]

Familial chylomicronemia Syndrome (FCS) is a genetic disorder characterized by impaired function of the enzyme lipoprotein lipase (LPL), leading to the inability to break down chylomicrons and the buildup of chylomicrons in the blood. Chylomicrons are lipoprotein particles primarily made up of triglycerides. This buildup results in a significant increase in triglyceride levels, severe abdominal […]

INSIDE THIS ISSUE Code Updates: Large Price Changes HCPCS Code Update for Makena Subcutaneous Auto-Injector NDC Crosswalk update for HCPCS Code(s) J7060 and J7070 (Dextrose) NDC Crosswalk update for HCPCS Code J0461 Reminder – NEW HCPCS Q-Codes effective July 1, 2018 NEW HCPCS C-Codes for Hospital OPPS Billing effective July 1, 2018 Deleted HCPCS Code […]

Hereditary transthyretin (TTR)-mediated amyloidosis (hATTR) is an inherited and debilitating disease that is characterized by mutations in the TTR gene. These gene mutations can cause accumulation of abnormal amyloid proteins in body organs and tissue, leading to damage of these areas, such as the peripheral nerves. Peripheral, autonomic, or cardiomyopathy can result from this accumulation […]

There were a total of three new FDA drug approvals in June that we deemed specific to the specialty market. In addition, there were six supplemental drug approvals. The FDA had assigned six new products for review. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

RJ Health has a new white paper available for download. Automated Controls for Medical Drug Spend by RJ Health’s Chief Innovation Officer, George Herchenroether – Appropriate reimbursement for drugs covered by the medical benefit requires more data and structure than most medical claims or billing systems were originally intended to process. This applies even more […]

New Drug Overview: Pegfilgrastim-jmdb (Fulphila™) The first FDA approved biosimilar to Pegfilgrastim (Neulasta®) Generic Name Brand Name Manufacturer Approval Date Anticipated Availability Accelerated Review Pegfilgrastim-jmdb Fulphila ™ Mylan GmbH June 4, 2018 In the coming weeks n/a Labeled Indication: Decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving […]