As of January 1, 2015 there will be some significant changes in the billing and reimbursement schedule for men receiving Bayer healthcare’s radium Ra223 dichloride (Xofigo). Xofigo is FDA approved for the treatment of men with castration-resistant metastatic prostate cancer (mCRPC) who have symptomatic bone metastases and no known visceral metastatic disease. These changes result from the following determinations from the Centers for Medicare & Medicaid Services (CMS).
• CMS has assigned a new permanent Healthcare Common Procedure Coding System (HCPCS) code to Xofigo. This code, A9606 (Radium ra-233 dichloride, therapeutic, per microcurie) will become effective this January 1, 2015. The code is mandated by CMS and is specifically designed to facilitate automated billing and reimbursement by the doctors and hospitals.
• Prior to the assignment of this code Xofigo was purchased and reimbursed at a flat patient ready dose (PRD), which meant that all patients paid the same no matter how much drug they received (Xofigo doses are calculated based upon a patients weight with heavier patients requiring more drug). Under the new CMS-mandated microcurie A-code, A9606, providers will have to purchase Xofigo and bill payers (insurance companies and patients without insurance) based on the number of microcuries administered (the amount of drug) to each patient, rather than per patient ready dose.
Bayer has indicated that for the average man the cost will not change. For men who are smaller their actual cost will decline and for heavier men their cost will increase.
Bayer has assured Malecare that it is committed to supporting patient access to Xofigo through its support programs for eligible uninsured and underinsured men. It also will continue its program to assist qualified men in meeting their co-insurance obligations.
If you need financial assistance in paying for Xofigo now or after January 1, 2015 you should contact Xofigo Access Services at 1-855-696-3446.
Joel T. Nowak, M.A., M.S.W.