Compendia information developed and maintained by. In each issue, Managed Care. Oncology s Drug & Administration. Compendia will highlight a single

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1 drug and administration compendia Compendia information developed and maintained by In each issue, Managed Care Oncology s Drug & Compendia will highlight a single medication or a group of medications that may be utilized in the management of one of the featured oncology disease states. This section will address such topics as: suggested ICD-9-CM coding possible medication(s) used to treat the conditions, including ancillary medication(s) clinical information regarding the use of the medications listed reimbursement and coding information (how to bill for new medications) HCPCS or CPT coding information current AWP-based pricing the most recent ASP Plus 6% (medicare allowable) possible administration codes that can be utilized with each medication 33

2 Medications currently available to treat renal cell carcinoma include: HCPCS Code Description Current Code Price - Effective Date Code Price (AWP) 1/1/06-3/31/06 ASP + 6% (Medicare Allowable) J0207 Amifostine, injection, 500 mg 10/03/05 $ $ , 90766, 90767, 90768, 90774, J1051 Medroxyprogesterone, injection, 50 mg 01/01/05 $6.32 $ J8530 Cyclophosphamide, oral, 25 mg 02/19/03 $2.26 $0.95 J9015 Aldesleukin, per single-use vial 06/03/05 $ $ , 96411, 96413, J9060 Cisplatin, powder or solution, per 10 mg 11/01/05 $6.25 $ , 96411, 96413, J9062 Cisplatin, 50 mg 11/01/05 $31.25 $ , 96411, 96413, J9070 Cyclophosphamide, 100 mg 09/01/01 $5.39 $ , 96411, 96413, J9080 Cyclophosphamide, 200 mg 09/01/01 $10.24 $ , 96411, 96413, J9090 Cyclophosphamide, 500 mg 09/27/04 $15.80 $ , 96411, 96413, J9091 Cyclophosphamide, 1.0 g 09/27/04 $28.45 $ , 96411, 96413, J9092 Cyclophosphamide, 2.0 g 09/27/04 $51.20 $ , 96411, 96413, J9093 J9094 J9095 J9096 J9097 Cyclophosphamide, lyophilized, 100 mg Cyclophosphamide, lyophilized, 200 mg Cyclophosphamide, lyophilized, 500 mg Cyclophosphamide, lyophilized, 1.0 g Cyclophosphamide, lyophilized, 2.0 g 12/01/01 $6.19 $ , 96411, 96413, 09/01/00 $11.76 $ , 96411, 96413, 09/01/00 $24.68 $ , 96411, 96413, 09/01/00 $49.37 $ , 96411, 96413, 09/27/04 $98.77 $ , 96411, 96413, J9190 Fluorouracil, 500 mg 01/19/05 $3.48 $ , 96411, 96413, J9200 Floxuridine, 500 mg 01/01/03 $ $60.81 J9213 J9214 Interferon, alfa-2a, recombinant, 3 million units Interferon, alfa-2b, recombinant, 1 million units 02/07/06 $46.34 $ , /06/04 $16.96 $ , J9360 Vinblastine, 1 mg 12/01/01 $3.31 $ , 96411, 96413, J9370 Vincristine, 1 mg 09/01/05 $10.00 $ , 96411, 96413, J9375 Vincristine, 2 mg 09/01/05 $20.00 $ , 96411, 96413, J9380 Vincristine, 5 mg 09/01/05 $50.00 $ , 96411, 96413, 34 managedcareoncology Spring 2006

3 Two new oral agents have recently been approved to treat renal cell carcinoma. The two drugs, sorafenib (Nexavar, Bayer/Onyx) and sunitinib (Sutent, Pfizer), are both indicated for use in advanced renal cell carcinoma Sorafenib Indications Sorafenib is indicated for the treatment of patients with advanced renal cell carcinoma. Associated ICD-9-CM Codes 189 Malignant Neoplasm of kidney and other and unspecified urinary organs Kidney, except pelvis Billing Instructions For each drug, the following information must appear on the CMS 1500 claim form for reimbursement. Column 24D and Box 19 Column 24D: Indicate the appropriate "J-Code" for the medication administered. In this case utilize J8999 prescription drug, oral, chemotherapeutic, not otherwise specified Box 19: Indicate the full name of the medication administered including strength (if applicable), (e.g., Nexavar 200 mg) as well as the National Drug Code (NDC) on the package used. Column 24F and Column 24G Column 24F: Medication charge Column 24G: Quantity of medication used (number of units) Additional sorafenib Product Information Warnings Nexavar may cause birth defects or fetal loss. Women of child bearing potential should be advised to avoid becoming pregnant while on Nexavar and for at least 2 weeks after stopping treatment. Dosing Information The recommended daily dose of sorafenib is 400 mg (2 x 200-mg tablets) taken orally twice daily. Sorafenib should be taken without food (at least 1 hour before or 2 hours after eating). Treatment should continue until the patient is no longer clinically benefiting from therapy or until unacceptable toxicity occurs. Management of suspected adverse drug reactions may require temporary interruption and/or dose reduction of sorafenib therapy. When dose reduction is necessary, the sorafenib dose may be reduced to 400 mg once daily. If additional dose reduction is required, sorafenib may be reduced to a single 400-mg dose every other day (see PRECAUTIONS in package insert). Box 19 Column 24F NDC Strength Current Code Price (AWP) as of 12/20/ mg tablet $45.14/tablet 35

4 Suggested Dose Modifications for Skin Toxicity Skin Toxicity Grade Occurrence Suggested Dose Modification Grade 1. Numbness, dysesthesia, paresthesia, tingling, painless swelling, erythema, or discomfort of the hands or feet which does not disrupt the patient s normal activities Grade 2. Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient s normal activities Grade 2. Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient s normal activities Any occurrence First occurrence No improvement within 7 days or second or third occurrence Continue treatment with sorafenib and consider topical therapy for symptomatic relief Continue treatment with sorafenib and consider topical therapy for symptomatic relief If no improvement within 7 days, see below Interrupt sorafenib treatment until toxicity resolves to Grade 0 1 If no improvement within 7 days, see below Grade 2. Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient s normal activities Fourth occurrence Discontinue sorafenib treatment Grade 3. Moist desquamation, ulceration, blistering or severe pain of the hands or feet, or severe discomfort that causes the patient to be unable to work or perform activities of daily living Grade 3. Moist desquamation, ulceration, blistering, or severe pain of the hands or feet or severe discomfort that causes the patient to be unable to work or perform activities of daily living First or Second occurrence Third occurrence Interrupt sorafenib treatment until toxicity resolves to Grade 0 1 When resuming treatment, decrease sorafenib dose by one dose level (400 mg daily or 400 mg every other day) Discontinue sorafenib treatment Storage Store at 25 C (77 F). Excursions permitted to C (59 86 F) (see USP-controlled room temperature). Store in a dry place. Sorafenib is available through the REACH program and is not available through retail pharmacies. To receive Nexavar the patient must be enrolled in REACH. Physicians can obtain patient enrollment forms by calling or via the Nexavar website. Once enrolled the drug is shipped directly to the patient s home. Sunitinib Indications Sunitinib is indicated for the treatment of gastrointestinal stromal tumor after disease progression on or intolerance to imatinib mesylate (Gleevec, Novartis). Sunitinib is indicated for the treatment of advanced renal cell carcinoma. Approval for advanced renal cell carcinoma was based on partial response rates and duration of responses. There are no randomized trials of sunitinib demonstrating clinical benefit such as increased survival or improvement in disease related symptoms in renal cell carcinoma. Billing Instructions For each drug, the following information must appear on the CMS 1500 claim form for reimbursement. Column 24D and Box 19 Column 24D: Indicate the appropriate "J-Code" for the medication administered. In this case utilize J8999 NDC Box 19 Strength Prescription drug, oral, chemotherapeutic, NOS or C9399: Unclassified drugs or biologicals (hospital use). Box 19: Indicate the full name of the medication administered including strength (if applicable), (eg, Sutent 50 mg) as well as the NDC on the package used. Column 24F and Column 24G Column 24F: Medication charge Column 24G: Quantity of medication used (number of units) Column 24F Current Code Price (AWP) as of 1/27/ mg capsule $66.80/capsule mg capsule $133.59/capsule mg capsule $267.19/capsule 36 managedcareoncology Spring 2006

5 Additional Product Information Drug Interactions Co-administration of sunitinib with strong inhibitors of the CYP3A4 family may increase sunitinib concentrations. These inhibitors include: - ketoconazole (Nizoral, Janssen) - itraconazole (Sporanox, Janssen) - clarithromycin (Biaxin, Abbott) - atazanavir (Reyataz, Bristol- Myers Squibb) - indinavir (Crixivan, Merck) - nefazodone (Serzone, Bristol- Myers Squibb) - nelfinavir (Viracept, Pfizer) - ritonavir (Norvir, Abbott) - saquinavir (Fortovase / Invirase, Roche) - telithromycin (Ketek, Sanofi-Aventis) - voriconazole (Vfend, Pfizer) Grapefruit may also increase plasma concentrations of sunitinib (see CLINICAL PHARMACOLOGY in package insert). Co-administration of sunitinib with inducers of the CYP3A4 family may decrease sunitinib concentrations (see CLINICAL PHARMACOLOGY in package insert). These inducers include: - dexamethasone (Decadron, Merck) - phenytoin (Dilantin, Pfizer) - carbamazepine (Tegretol, Novartis) - rifampin (Rifadin, Sanofi-Aventis) - rifabutin (Mycobutin, Pfizer) - rifapentine (Priftin, Sanofi-Aventis) - phenobarbital - St. John s Wort St. John s Wort may decrease sunitinib plasma concentrations unpredictably. Patients receiving sunitinib should not take St. John s Wort concomitantly. Sutent dose modification is recommended in patients using concomitant CYP3A4 inhibitors or inducers (see Dosage and ). Dosage and The recommended dose of Sutent for gastrointestinal stromal tumor (GIST) and advanced renal cell carcinoma is one 50-mg oral dose taken once daily, on a schedule of 4 weeks on treatment followed by 2 weeks off. Sutent may be taken with or without food. Dose Modification Dose increase or reduction in 12.5-mg increments is recommended based on individual safety and tolerability. Strong CYP3A4 inhibitors (see Drug Interactions above) may increase sunitinib plasma concentrations. Selection of an alternate concomitant medication with no or minimal enzyme inhibition potential is recommended. A dose reduction for sunitinib to a minimum of 37.5 mg daily should be considered if sunitinib must be co-administered with a strong CYP3A4 inhibitor (see CLINICAL PHARMACOLOGY and PRECAUTIONS, Drug Interactions, in package insert). 37

6 CYP3A4 inducers (see Drug Interactions on previous page) may decrease sunitinib plasma concentrations. Selection of an alternate concomitant medication with no or minimal enzyme induction potential is recommended. A dose increase for sunitinib to a maximum of 87.5 mg daily should be considered if sunitinib must be co-administered with a CYP3A4 inducer. If the dose is increased, the patient should be monitored carefully for toxicity (see CLINICAL PHARMACOLOGY and PRECAUTIONS, Drug Interactions, in package insert). Storage Store at 25 C (77 F); excursions permitted to C (59 86 F) (see USP-controlled room temperature). Sunitinib is available through retail pharmacies. Pharmacies must call (800) once a prescription is received for sunitinib. Sunitinib will then be shipped directly to the pharmacy for dispensing to the patient. References HCPCS Level II Expert, 2004/5/6 Current Procedural Terminology (CPT) 2005/2006 ICD-9-CM for Physicians; Volumes 1 and 2 Drug Bulletin by the Association of Community Cancer Centers The NCCN Drugs and Biologicals Compendium by the National Comprehensive Cancer Network; Version , Kidney Cancer Nexavar and Sutent package inserts The Drug Reimbursement Coding and Pricing Guide by R J Health Systems International, LLC; Volume 3, Number 1; 1st Quarter The information presented in this compendia was supplied by R J Health Systems International, LLC, Wethersfield, CT. 38 managedcareoncology Spring 2006

7 Oncology Related J Codes For roughly a 1 million life healthcare plan, ICORE Healthcare found that claims for 96 HCPCs J codes summed to $65 million, the top 30 codes totaled $56 million (approximately 86% of the J code spend). ICORE Healthcare also found that of these top 30 codes, 23 of them were oncology related codes, which comprised $45 million. It is our belief that these codes should be tracked, so we have complied the following table for your reference: HCPS Code Description FDA-Approved Uses Compendia Approved Uses AWP ASP+6 J0881/ J0882 Darbepoetin Alfa Aranesp Anemia in Chronic Kidney Disease (285.21) Anemia in Neoplastic Disease (285.22) Anemia in chronic kidney disease (285.21) Anemia in neoplastic disease (285.22) Anemia, unspecified (285.9) $5.56 $ J0885/ J0886 Epoetin Alfa Procrit Epogen Anemia in Chronic Kidney Disease (285.21) Anemia in Neoplastic Disease (285.22) Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues (238.7) Anemia in chronic illness (285.2) Anemia, unspecified (285.9) $14.71 $ J2505 Pegfilgrastim Neulasta Diseases of White Blood Cells- Agranulocytosis (288.0) Diseases of white blood cellsagranulocytosis (288.0) $3, $2, J9310 Rifuximab Rituxan Lymphosarcoma and Reticulosarcoma (200._) Other Malignant Neoplasms of Lymphoid and Histocytic Tissue (202._) Rheumatoid Arthritis and other inflammatory Polyarthropathies (714._) Lymphoid leukemia chronic (chronic lymphocytic leukemia) (204.1_) Primary thrombocytopenia (immune or idiopathic throm-bocytopenic purpura) (287.3) Disorders of plasma protein metabolismmacroglobulinemia (waldenstrom macroglobulinemia) (273.3) $ $ J9263 Oxaliplatin Eloxatin Malignant Neoplasm of Colon (153._) Malignant Neoplasm of Rectum, Rectosigmoid junction, and Anus (154._) Malignant Neoplasm of ovary and other Uterine Adnexa (Advanced Ovarian cancer) (183._) Other Malignant Neoplasms of lymphoid and histocytic tissue (relapsing or refractory non-hodgkin s lymphoma) (202._) $10.65 $ J9170 Docetaxel Taxotere Breast cancer: for the treatment of patients with locally advanced or metastatic breast cancer after failure of prior chemotherapy. (174.,175. ) Non-small cell lung cancer: as a single agent for the treatment of patients with locally advanced or metastatic NSCLC after failure of prior platinum-based chemotherapy. Also in combination with cisplatin for the treatment of patients with unresectable locally advanced or metastatic Non-small Cell Lung Cancer who have not previously received chemotherapy for this condition. (162. ) Prostate cancer: in combination with prednisone for the treatment of patients with androgen independent (hormone refractory) metastatic prostate cancer. (185. ) Malignant Neoplasm of Lip (140. ) Malignant Neoplasm of Tongue (141. ) Malignant Neoplasm of major Salivary glands (142. ) Malignant Neoplasm of Gum (143. ) Malignant Neoplasm of floor of Mouth (144. ) Malignant Neoplasm of other and unspecified parts of mouth (145. ) Malignant Neoplasm of Oropharynx (146. ) Malignant Neoplasm of Nasopharynx (147. ) Malignant Neoplasm of Hypopharynx (148. ) Malignant Neoplasm of other and ill-defined sites within the Lip, Oral Cavity, and Pharynx (149. ) Malignant Neoplasm of Esophagus (150. ) Malignant Neoplasm of Stomach (151. ) Malignant Neoplasm of Nasal Cavities, Middle Ear, and Accessory Sinuses (160. ) Malignant Neoplasm of larynx (161. ) Malignant Neoplasm of ovary and other uterine adnexa (183. ) Malignant Neoplasm of bladder (188. ) Malignant Neoplasm of other and ill-defined sites (195. ) Malignant melanoma (172. ) $ $

8 HCPS Code Description FDA-Approved Uses Compendia Approved Uses AWP ASP+6 J9035 Bevacizumab Avastin Malignant Neoplasm of colon (153._) Malignant Neoplasm of rectum, rectosigmoid junction and anus (154._) Malignant Neoplasm of kidney and other and Unspecified Urinary Organs (metastatic renal cell carcinoma) (189._) Malignant Neoplasm of trachea, bronchus, and lung (small-cell, non-squamous lung cancer) (162._) $68.75 $ J9217 Leuprolide Acetate Lupron Eligard Advanced prostatic cancer (injection, implant, or depot 7.5, 22.5, and 30 Mg): palliative treatment of advanced prostatic cancer that offers an alternative when orchiectomy or estrogen administration are not indicated or are unacceptable to the patient. (185. ) Endometriosis (depot 3.75 and Mg): management of endometriosis, including pain relief and reduction of endometriotic lesions. Experience is limited to women > 18 years of age treated for <6 months. (617.9) Uterine leiomyomata (fibroids) (depot 3.75 and Mg): concomitantly with iron therapy for the preoperative hematologic improvement of patients with anemia caused by uterine leiomyomata. Experience with leuprolide depot in females has been limited to women > 18 years of age and treated for <6 months. (218.9) Central precocious puberty (CPP) (pediatric injection or depot-ped): treatment of children with CPP. (259.1) Malignant Neoplasm of female breast (174. ) Malignant Neoplasm of male breast (175. ) Malignant Neoplasm of body of uterus (182. ) Malignant Neoplasm of ovary and other uterine adnexa (183. ) $ $ J9355 Trastuzumab Herceptin Breast Cancer: for the treatment of metastatic breast cancer with tumors overexpressing the Human Epidermal Growth Factor Receptor 2 (HER2) protein: 1) as a single agent in patients who have received > 1 chemotherapy regimens; or 2) in combination with paclitaxel in patients who have not received chemotherapy for their metastatic disease. Use only in patients whose tumors have HER2 protein overexpression (174., 175. ) NA $67.90 $ J9201 Gemcitabine Hydrochloride Gemzar Breast cancer: gemcitabine in combination with paclitaxel is indicated for the firstline treatment of patients with metastatic breast cancer after failure of prior anthr cycline-containing adjuvant chemotherapy, unless anthracyclines were clinically contraindicated. (174.,175. ) Non-small Cell Lung Cancer: in combination with cisplatin for the first-line treatment of patients with inoperable, locally advanced (stage IIIa or IIIb) or metastatic (stage IV) non-small cell lung cancer. (162. ) Pancreatic cancer: first-line treatment for patients with locally advanced (nonresectable stage II or stage III) or metastatic (stage IV) adenocarcinoma of the pancreas. gemcitabine is indicated for patients previously treated with 5-fluorouracil (5-fu). (157. ) Malignant Neoplasm of gall bladder and extrapepatic bile ducts (156. ) Malignant Neoplasm of retroperitoneum and peritoneum (158. ) Malignant Neoplasm of thymus, heart, and mediastinum (164. ) Malignant Neoplasm of placenta (181. ) Malignant Neoplasm of ovary and other uterine adnexa (183. ) Malignant Neoplasm of testis (186. ) Malignant Neoplasm of other endocrine glands and related structures (194. ) Lymphosarcoma and reticulosarcoma (200. ) Hodgkin s disease (201. ) Other malignant Neoplasms of lymhoid and histiocytic tissue (202. ) Malignant Neoplasm of tongue (141. ) Malignant Neoplasm of major alivary gland (142. ) Malignant Neoplasm of gum (143. ) Malignant Neoplasm of floor of mouth (144. ) $ $ managedcareoncology Spring 2006

9 HCPS Code Description FDA-Approved Uses Compendia Approved Uses AWP ASP+6 J9045 Carboplatin Paraplatin Advanced ovarian carcinoma: (183. ) Initial treatment: for the Initial treatment of advanced ovarian carcinoma in established combination with other approved chemotherapeutic agents. One established combination regimen consists of carboplatin and cyclophosphamide. Secondary treatment: for the palliative treatment of patients with ovarian carcinoma recurrent after prior chemotherapy, including patients who have been previously treated with cisplatin. Malignant Neoplasm of other and unspecified parts of Mouth (145. ) Malignant Neoplasm of oropharynx (146. ) Malignant Neoplasm of nasopharynx (147. ) Malignant Neoplasm of hypopharynx (148. ) Malignant Neoplasm of Neoplasm of other and ill-defined sites within the lip, oral cavity, and pharynx (149. ) Malignant Neoplasm of esophagus (150. ) Malignant Neoplasm of nasal cavities, middle ear, and accessory sinuses (160. ) Malignant Neoplasm of retroperitoneum and peritoneum (158. ) Malignant Neoplasm of larynx (162. ) Malignant Neoplasm of trachea, bronchus, and lung (162. ) Malignant melanoma of skin (172. ) Malignant Neoplasm of femal breast (174. ) Malignant Neoplasm of male breast (175. ) Malignant Neoplasm of cervix uteri (180. ) Malignant Neoplasm of body of uterus (182. ) Malignant Neoplasm of ovary and other uterine adnexa (183. ) Malignant Neoplasm of testis (186. ) Malignant Neoplasm of bladder (188. ) Malignant Neoplasm of brain (191. ) Malignant Neoplasm of other endocrine glands and related structures (194. ) Malignant Neoplasm of other and ill-defined sites (195. ) Secondary malignant Neoplasm of respiratory and digestive systems (197. ) Malignant Neoplasm without specification of site (199. ) Lymphosarcoma and reticulosarcoma (200. ) Hodgkin s disease (201. ) Other malignant Neoplasms of lymphoid and histiocytic tissue (202. ) Wilm s tumor (189.0) $85.10 $ J3487 Zoledronic Acid Zometa Hypercalcemia (275.42) Multiple myeloma (203.0) Bone and bone marrow (198.5) Bone and bone marrow (198.5) Multiple myeloma (203.0_) Hypercalcemia (275.42) Disorder of bone and cartilage, unspecified (733.90) $ $ J9265 Paclitaxel Onxol Taxol Onxol : Malignant Neoplasm of ovary and other uterine adnexa (183._) Malignant Neoplasm of female breast (174._) Malignant Neoplasm of male breast (175._) Taxol : Maligant Neoplasm of ovary and other uterine adnexa (183._) Malignant Neoplasm of female breast (174._) Malignant Neoplasm of male breast (175._) Malignant Neoplasm of trachea, bronchus, and lung (162._) Kaposi s sarcoma (176._) Malignant Neoplasm of trachea, bronchus, and lung (small cell lung cancer) (162._) Malignant Neoplasm of bladder (bladder cancer) (188._) Malignant Neoplasm of uterus (endometreal cancer) (182.0) Malignant Neoplasm of esophagus (esophageal cancer) (150._) Malignant Neoplasm of prostate (prostate cancer) (185._) Malignant Neoplasm of stomach (gastric cancer) (151._) Malignant Neoplasm of testis (testicular cancer) (186._) Malignant Neoplasm of lip (head and neck ) (140._) Malignant Neoplasm of tongue (head and neck) (141._) Malignant Neoplasm of major salvary glands (head and neck) (1421._) $ $

10 HCPS Code J9265 Cont. Description FDA-Approved Uses Compendia Approved Uses AWP ASP+6 Malignant Neoplasm of Gum (Head and Neck) (143._) Malignant Neoplasm of floor of Mouth (Head and Neck) (144._) Malignant Neoplasm of other and unspecified parts of Mouth (Head and Neck) (145._) Malignant Neoplasm of Oropharynx (Head and Neck) (146._) Malignant Neoplasm of Nasopharynx (Head and Neck) (147._) Malignant Neoplasm of Hypopharynx (Head and Neck) (148._) Malignant Neoplasm of other and illdefined sites within the Lip, Oral Cavity, and Pharynx (Head and Neck) (149._) Malignant Neoplasm of Nasal Cavities, Middle Ear, and accessory Sinuses (Head and Neck) (160._) Malignant Neoplasm of Larynx (Head and Neck) (161._) Malignant Neoplasm of other ill defined sites-head, Face and Neck (Head and Neck) (195.0) Malignant Neoplasm of Retroperitoneum and peritoneum-specific parts of Peritoneum (peritoneal) (158.8) Malignant Neoplasm of Retroperitoneum and Peritoneum-peritoneum, unspecified (Peritoneal) (158.9) Malignant Neoplasm of Ovary and other Uterine Adnexa Fallopian tube (Fallopian tube) (183.2) Malignant Neoplasm of Cervix Uteri (Cervix) (180._) Malignant Neoplasm without specification of site-disseminated (Cancer of Unknown Primary) (199.0) Malignant Neoplasm without specification of site-other (Cancer of Unknown Primary) (199.1) J2469 Palonosetron Hydrochloride Aloxi Symptoms involving digestive systemnausea with vomiting (787.01) Symptoms involving digestive systemnausea with vomiting (787.01) Symptoms involving digestive systemvomiting alone (787.03) Certain adverse effects not elsewhere classified-unspecified adverse effect of drug, medicinal and biological substance (995.2) $37.20 $ C8950 J9206 Irinotecan HCL Camptosar Metastatic Carcinoma of the Colon or Rectum: first-line therapy in combination with 5-fluorouracil (5-fu) and leucovorin for patients with metastatic colon or rectal carcinomas. It is also indicated for the treatment of metastatic carcinoma of the colon or rectum in patients whose disease has recurred or progressed following initial 5-fu-based therapy. (153.,154. ) Malignant Neoplasm of trachea, bronchus, and lung (162. ) Malignant Neoplasm of cervix uteri (180. ) Malignant Neoplasm of stomach (151. ) Malignant Neoplasm of brain (191. ) $ $ J9055 Cetuximab Erbitux Metastatic Colorectal Carcinoma: used in combination with irinotecan for the treatment of epidermal growth factor receptor (EGFR)-expression, metastatic colorectal carcinoma in patients who are refractory to irinotecan-based chemotherapy; as a single agent for the treatment of EGFR-expressing, metastatic colorectal carcinoma in patients who are intolerant to irinote can-based chemotherapy. (153.,154. ) NA $60.00 $ managedcareoncology Spring 2006

11 FDA-Approved Uses Compendia Approved Uses AWP ASP+6 J0180 Agalsidase Beta Fabrazyme Lipidoses- Fabry s disease (272.7) NA $ $ C8950 C8951 J1950 (3.75mg) Leuprolide Acetate Lupron Leiomyoma of Uterus (218.9) Endometriosis, site unspecified (617.9) Malignant Neoplasm of Female Breast (174._) Malignant Neoplasm of Prostate (185) Endometriosis (617._) $ $ J9305 Pemetrexed Disodium Alimta Malignant Neoplasm of pleura (163._) Malignant Neoplasm of trachea, bronchus, and lung (162._) NA $51.22 $ J9041 Bortezomib Velcade Multiple myeloma and immunoproliferative Neoplasmsmultiple myeloma (203.0_) Malignant Neoplasms of Lymphoid and Histiocytic tissue (Mantle Cell Lymphoma) (202.8) $38.39 $ C8953 J9001 Doxorubicin Hydrocloride Liposome Doxil Malignant Neoplasm of ovary and other uterine adnexa (183._) Kaposi s sarcoma (176._) Malignant Neoplasm of Female Breast (Refractory breast cancer) (174._) Malignant Neoplasm of Male Breast (Refractory Breast Cancer) (175._) Multiple Myeloma and Immunoproliferative Neoplasms-Multiple Myeloma (Multiple Myeloma) (203.0) $ $ J1626 Granisetron Hydrochloride Kytril Symptoms involving digestive systemnausea with vomiting (787.01) Symptoms involving Digestive System- Nausea with vomiting (787.01) Symptoms involving Digestive Systemvomiting alone (787.03) Certain adverse effects not elsewhere classified-unspecified adverse effect of drug, medicinal and biological substance (995.2) $12.03 $ C8952 C8950 J1440 (300 mcg) J1441 (480 mcg) Filgrastim Neupogen Agranulocytosis (288.0) Other specified disease of white blood cells (288.8) Myeloid leukemia (205._) Monocytic leukemia (206._) Other specified leukemia (207._) Leukemia of unspecified cell typeacute-in remission (208.01) Other lymphatic and hematopoietic tissues (238.7) Agranulocytosis (288.0) $ (J1440) $ (J1441) $ (J1440) $ (J1441) C8950 C