http://www.medicalpolicy.hcsc.net/medicalpolicy/pendingPolicyPage?lid=jf6p8pue WebPolicy Name: Exondys 51_Vyondys 53 Type of Submission – Check all that apply: X Revised Policy New Policy ... CPT Codes / HCPCS Codes / ICD -10 Codes Code Code Description 96365 - 96368 ; Intravenous infusion, for therapy, prophylaxis or diagnosis ; 96369 - 96372 ;
Policy Title: Exondys 51 (eteplirsen) Department: PHA
WebC9484PA required Exondys 51 Eteplirsen, 10 mg C9485PA required Lartruvo Olaratumab, 10 mg C9486PA required Sustol Granisetron extended release, 0.1 mg C9487PA required Stelara Ustekinumab, for intravenous injection, 1 mg C9488PA required Vaprisol Conivaptan hydrochloride, 1 mg C9489PA required Spinraza Nusinersen, 0.1 mg WebHCPCS Codes Description C9075 Injection, casimersen, 10 mg (Code deleted 09/30/2024) J1426 Injection, casimersen, 10 mg . ... Exondys 51 (eteplirsen intravenous infusion) is mentioned as an emerging product, approved by an accelerated pathway for those with a mutation in the dystrophin gene amenable to exon 51 skipping. s\u0026p 500 micro index options barchart
Clinical Policy: Eteplirsen (Exondys 51) - Superior HealthPlan
WebList is sorted alphabetically by HCPCS Code Last Updated 07/21/2024 If unable to locate in Novologix portal, please fax to AvMed at 305‐671‐0189 Page 1 of 8. MEDICATION AUTHORIZATION WORKFLOW FOR DRUGS THAT REQUIRE PRIOR‐AUTHORIZATION ... J1428 Exondys 51 Eteplirsen Novologix Novologix J1429 Vyondys 53 Golodirsen … WebSep 2, 2024 · Exondys 51 is prescribed by, or in consultation with, a neurologist with expertise in the treatment of DMD; AND ... The following HCPCS/CPT codes are: HCPCS/CPT Code Description J1428 Injection, eteplirsen, 10 mg References: 1. Exondys 51 [package insert]. Cambridge, MA: Sarepta Therapeutics, Inc, July 2024. s\u0026p 500 max drawdown by year