Wiki Retacrit payment - Outpatient hospital facility

TammyInMi

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I work in a Oncology/Hematology department that is in a outpatient hospital facility. Our hospital system changed formulary from Procrit J0885 to Retacrit (bio-similar) Q5106 at the start of 2019. We are getting denials for payment for the Retacrit with use in Myelodysplastic Syndrome patients D46.9. Is anyone else having this same issue? The EOB's come back as "experimental use". Any help would be much appreciated.

Thanks!
Tammy:confused:
 
Retacrit

Good Day,

I would recommend you look at your carrier guidelines for this drug for the condition involved. Additionally, I would check the FDA website to see if the drug is approved for Cancer treatment. Please see the link below. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm.

Good Luck

Roslyn Jones-Stewart
President Durham Local Chapter
Reach One Teach One
 
Retacrit

Depends on the carrier you are billing. Sales reps are pushing this drug for all indications (and the guidelines being provided by our pharmaceutical supplier follow this). However if you look at the actual Medicare policy, Medicare only covers Retacrit as medically necessary for ESRD and CKD usage. I went round and round with my pharmacists about this.

When in doubt, check the medical policy guidelines.
 
Retacrit Dosing

I'm looking for some help finding information regarding administering Retacrit. We are interested in switching from Procrit to Retacrit, however, most of our patients are receiving 20,000 units of Procrit. Retacrit comes in 2k, 3k, 4k, and 10,000. Is 10,000 of Retacrit equivalent to 10,000 of Procrit? At the risk of sounding stupid, we didn't want to assume. (If so, it looks like the patient will receive 2 injections of 10,000 at each visit.)

Thank you
 
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