Category Archives: Industry Insights

Each year there are dozens of new drugs (56 in 2018) and new CMS HCPCS assignments (38 in January 2018), as well as hundreds of new indications approved. This is in addition to the ongoing updates in coding assignments, pricing, generic entries and more. Consider that the average cost for a medically covered drug is […]

NDC mandates have been in place for Medicaid covered lives for over a decade. In recent years, this requirement has been expanded to account for additional lines of business. This shift creates a larger member population which in turn creates new claim volume. The addition of the volume mixed with the requirement for electronic claim […]

INSIDE THIS ISSUE Code Updates: Large Price Changes New Q-Codes Effective October 1, 2018 New C-Codes for Hospital OPPS use Effective October 1, 2018 CMS News: Medicare Influenza Vaccine Pricing 2018-2019 Season NEW Influenza CPT® Code 90689 Effective January 1, 2019 Medicare Coverage Indicator Change for Q9994 Drug Reimbursement Code Price Updates Drugs/Devices: New Clinical […]

RJ identified a total of seven new FDA drug approvals specific to the specialty market in August 2018, and six supplemental drug approvals. The FDA had assigned four new products for review. Review the August 2018 RJ Health monthly specialty FDA actions newsletter below for more information. Drugs included in this review are generally regarded […]

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. Currently, the mainstay […]

FDA Approval: 8/8/2018 Mogamulizumab-kpkc is a humanized monoclonal antibody developed by Kyowa Hakko Kirin Co., Ltd. for the treatment of cutaneous T-cell lymphomas, T-cell leukemia, and T-cell lymphomas. Mogamulizumab has shown promising efficacy in treating Cutaneous T-Cell Lymphoma (CTCL) in a phase III trial. The FDA granted mogamulizumab a Breakthrough Therapy Designation on August 25, […]

FDA Approval: 8/10/2018 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 […]

New Drug Overview – iobenguane I 131 (Azedra®) On July 30, 2018, the U.S. Food and Drug Administration (FDA) approved iobenguane I 131 (Azedra®) for treatment of adults and adolescents age 12 and older with unresectable pheochromocytoma or paraganglioma that has metastasized or is locally advanced and requires systemic anticancer therapy.  Patients must test positive […]

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

Control your Medical Drug Spend.  Learn about medical benefit drug pricing trends. Webinar: Addressing Escalating Medical Benefit Drug Pricing In this new webinar, Addressing Escalating Medical Benefit Drug Pricing, we will break down topics like: How to identify price trends for medically billed drugs and the reasons behind those trends. How to identify the top drug […]