Category Archives: Educational Resources

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

You have to take into account multiple considerations based on the NDC that is being billed, such as the dose for a pediatric patient billed differently from an adult dose, so each may crosswalk to a unique code. Whether the NDC designates a single dose or a multi-dose vile could affect the unit conversion.   […]

FDA Approval: 11/2/18 Febrile neutropenia is a complication that can occur in cancer patients receiving chemotherapy. Normally, neutrophils (a type of white blood cell) protect against infections; however, chemotherapy treatments may cause a reduction in neutrophils to abnormal levels in cancer patients, known as neutropenia. When significant neutropenia occurs in the presence of a fever, […]

INSIDE THIS ISSUE Code Updates: Update -J-Code 1599 Addition of 12 active NDCs Update- Removal of minimum and maximum dosing for J1325 and J3285 Update- Revision of maximum dose for J2278  CMS News: Medicare Influenza Vaccine Pricing 2018-2019 Season NEW Influenza CPT® Code 90689 Effective January 1, 2019 NEW HCPCS® Codes and Changed Code Descriptions […]

Hello. I am Wendy Sullivan, Director of Drug Informatics for RJ Health. I’d like to welcome you to today’s webinar-Creating Pre-Payment Controls for Medically Covered Drug Costs through Automation. Before we get started, I’d like to thank you for attending and to thank my colleagues who helped make this webinar possible. In terms of my […]

FDA Approval: 10/5/2018 Familial amyloid polyneuropathy (FAP, also called transthyretin amyloidosis) is a hereditary neurodegenerative disease that is characterized by the accumulation and deposition of the transthyretin protein (TTR) in the tissues and peripheral nervous system, and often causes pain, muscle weakness, and autonomic dysfunction. Eventually, the disease progresses into a sensory and motor polyneuropathy. […]

FDA Approval: 9/28/2018 Cutaneous squamous cell carcinoma (CSCC) is the second most deadly skin cancer following melanoma. CSCC leads to about 3,900 to 8,800 deaths per year in the United States. Prior to Cemiplimab approval, there were no FDA-approved treatments for advanced CSCC which is metastatic or where surgery is not an option. The rarity […]

Many medically covered drugs are costly, and processing errors can have significant implications. By 2020, it is estimated that more than half of specialty drug claim costs will be submitted through the medical benefit. Join Wendy Sullivan, Director of Data Informatics, on October 11th, 2pm EST, as she walks through the common issues and solutions […]

FDA Approval: 9/14/18 Migraine is a debilitating disorder that affects millions of people in the United States. Migraine can affect individuals in a way that deprives them of their normal, daily activities, and often results in pain, physical impairment, lost productivity, and increased financial cost. Fremanezumab-vfrm, developed by Teva Pharmaceutical Industries Ltd., is a fully […]

FDA Approval: 9/13/2018 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 […]