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Oncology & Hematology Coding Alert

News Flash:

New Drug, No Code

Published on Fri Jun 01, 2001

The FDA has approved a new anti-cancer drug for patients with chronic myeloid leukemia (CML), but Medicare reimbursement will not accompany it. According to HCFA, Gleevec, is a self-administered drug, and therefore not reimbursable. Physicians are limited to prescribing the drug and the patient is responsible for the cost. Novartis, the maker of Gleevec, says the drug will cost $2000 to $2400 per month.

According to a Novartis spokeswoman, commercial payer reimbursement should be done by obtaining prior approval. In addition, physicians can place their patients on a Novartis registry by calling (888) 669-6682. By doing so, the company will contact insurers directly to help patients obtain coverage.

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