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What value did the manufacturer place on bleed prevention with Hemlibra (emicizumab-kxwh) versus on-demand treatment with current bypassing agents? On November 16, 2017, the FDA announced the approval of Hemlibra (emicizumab-kxwh), a first-in-class monoclonal antibody for the prevention or reduction in the frequency of bleeding episodes in patients with hemophilia A who have factor VIII […]

ReimbursementCodes.com WEBINAR – February 1st, 2:00PM EST Solving for Incorrectly Mapped NDC to HCPCS/CPT® Codes And Improperly Reported NDC Units: In discussions with our customers regarding Medical Pharmaceuticals claims, over 30% submitted with an NDC had an incorrectly mapped HCPCS/CPT® Code and/or improperly reported NDC units. These types of errors may lead to miscalculated reimbursement rates, […]

INSIDE THIS ISSUE WEBINAR – February 1st, 2:00PM EST:         • Solving for Incorrectly Mapped NDC to HCPCS/CPT® Codes And Improperly Reported NDC Units Blog Updates:         • Rituxan (Rituximab) Biosimilars – 2018 Drug Pipeline Review         • Trends in FDA approval of Specialty Drugs 1990 through 2017 HCPCS Drug Code Updates:         • Large Price Changes         • Reminder – NEW HCPCS […]

Rituxan (Rituximab) is utilized as one of the treatment options for rheumatoid arthritis (RA), Non-Hodgkins Lymphoma (NHL), Chronic Lymphocytic Leukemia (CLL), and Wegner’s Granulomatosis (WG). In 2016 Rituxan had over $4 billion in sales in the United States, making it a lucrative area for the development of biosimilars.  As of the publication of this article, […]

Intro: There are several publications on the Food and Drug Administration’s (FDA) activities over time, but specific information on specialty drug approvals and trends since 1990 are difficult to find. Our overall purpose for this blog is to review the history of approvals and trends since 1990 for specialty medically covered drug.  Initially, we will […]

Myasthenia Gravis is a neuromuscular disorder that impacts over 50 thousand patients in the United States (U.S.). Of those patients that are diagnosed, approximately 95 percent are treated with immunosuppressants, intravenous immunoglobulin, and/or plasma exchange. The total number of treated patients is expected to grow at an annual rate of 1.7 percent.  Of those patients […]

Did you know : that healthcare fraud estimates in the United States exceed $68 billion annually? Did you know : the Federal Government won or negotiated over $2.5 billion in health care fraud judgments and settlements worth a total of over $1.9 billion in FY 2015? Did you know : that when differentiating fraud from waste and abuse, the […]

Are you weighing the decision to enforce an NDC mandate on ALL Medical Pharmacy Claims? RJ Health’s Analytics team shares the pro’s & con’s of NDC mandates across Pricing, Formulary, and Network Quality Considerations. Here are some practical examples to help illustrate how, at the end-of-the-day, RJ Health believes the answer to the NDC vs. […]

On September 14, 2017, the Food and Drug Administration approved the first biosimilar for Genentech’s Avastin® (bevacizumab), which is the first oncological biosimilar product on the U.S. market.Avastin is approved for eight oncological indications, two of which have an orphan drug exclusivity through 2021.The approval of Amgen’s Mvasi™ (bevacizumab-awwb) includes 6 indications (Table 1). The […]

On August 3, 2017 the Food and Drug Administration approved a liposome-encapsulated combination of daunorubicin and cytarabine (VYXEOS™, Jazz Pharmaceuticals, Inc.) for the treatment of adults with newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC), which are two types of AML having a poor prognosis. VYXEOS is the first agent that […]