Frontpage Discussions Pharm Tech Medicae B Billing — Akynzeo

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  • #10488
    Michelle
    Participant

    I have a patient that gets IV chemotherapy every 6 weeks. To help with the nausea and vomiting, she is prescribed oral Akynzeo and oral dexamethasone.

    We send the oral akynzeo to Walgreens and this is billed via Medicare Part B. Yes, Medicare B not D. Because this is medicare B, she can only fill the Akynzeo 3 days prior to her treatment (limited time frame) and there is a form that needs to be filled out each time BEFORE Medicare B will pay for the medication.

    The communication between Walgreens and our office – is awful. We fax the form, they say they never received it; the cycle goes on and on and repeats. And the poor patient worries about this every 6 weeks.

    Are you aware of any pharmacies that can bill part B for Akynzeo? I have asked ONCO 360, Briova, Bio Plus, and Specialty Century Script – and no one can bill this via Medicare B.

    Thoughts? Suggestions? Ever bill Akynzeo via Medicare B?

    I think at this point enrolling her in the free drug program would be easier.

    #10489
    Claire
    Participant

    If you’re in NC or SC, Atrium Health Specialty Pharmacy Services can bill Medicare B with no issue. They keep on top of everything, and are very organized.

    #10490
    Brandi
    Participant

    Wow. We haven’t billed Medicare B for Akynzeo, only Part D. I would think CVS Specialty can bill it. I’m trying to figure out what form Walgreens needs for each fill. I know when we bill other Medicare Part B drugs, we have to get a signed Medicare B Physician Form for each new script, but not with each fill if refills are given. Also, they should be able to fill every 30 days. I wouldn’t think that would be cutting it close to her treatment if that’s every 6 weeks.

    I’m curious how it was approved for Part B. Is it fulling replacing the IV antiemetic, or is it part of a 3-drug combo? I ask because you can do a policy search on cms.gov for antiemetic coverage policies.

    #10581
    Michelle
    Participant

    The form we have to fill out and send back to Walgreens in order to fill the Akynzeo via Medicare B is called a “oral antiemetic detailed written order” form. Then this is faxed back to their Danville, IL Walgreens at 1-866-855-5888.

    This is a full replacement for an IV anti-emetic. She receives Istodax and then takes the oral Akynzeo.

    I will check the CMS.gov website. thanks.

     

     

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