Drugs Used for the Treatment of Select Malignancies and Their Associated Codes and Pricing

Drugs Used for the Treatment of Select Malignancies and Their Associated Codes and Pricing

Pricing and Coding Provided By:

These detailed tables of codes and pricing related to drugs used to treat breast cancer, lung cancer, gynecologic malignancies, and hematologic malignancies are intended to assist practice managers, other healthcare providers, and payers to ensure the proper use of coding and billing information associated with the treatment of their patients.

Table 1HCPCS Codes and Prices

Breast Cancer

Generic (brand) name

gemcitabine in 0.9% sodium chloride injection (Infugem)

Indication(s)

MBC

HCPCS code/description

J9199^a-injection, Infugem 200 mg

Manufacturer

Sun Pharmaceuticals

WAC per HCPCS unit

$76.00

AWP per HCPCS unit

$91.20

Generic (brand) name

trastuzumab-pkrb injection (Herzuma)

Indication(s)

HER2-overexpressing breast cancer

HCPCS code/description

Q5113-injection, trastuzumab-pkrb, biosimilar, 10 mg

Manufacturer

Teva

WAC per HCPCS unit

$93.50

AWP per HCPCS unit

$112.20

Lung Cancer

Generic (brand) name

durvalumab injection (Imfinzi)

Indication(s)

extensive-stage SCLC; NSCLC

HCPCS code/description

J9173-injection, durvalumab, 10 mg

Manufacturer

AstraZeneca

WAC per HCPCS unit

$73.30

AWP per HCPCS unit

$87.96

Generic (brand) name

gemcitabine in 0.9% sodium chloride injection (Infugem)

Indication(s)

NSCLC

HCPCS code/description

J9199^a-injection, Infugem 200 mg

Manufacturer

Sun Pharmaceuticals

WAC per HCPCS unit

$76.00

AWP per HCPCS unit

$91.20

Generic (brand) name

nivolumab injection (Opdivo)

Indication(s)

NSCLC; SCLC

HCPCS code/description

J9299-injection, nivolumab 1 mg

Manufacturer

Bristol Myers Squibb

WAC per HCPCS unit

$27.42

AWP per HCPCS unit

$32.90

Generic (brand) name

pembrolizumab injection (Keytruda)

Indication(s)

NSCLC; SCLC

HCPCS code/description

J9271-injection, pembrolizumab, 1 mg

Manufacturer

Merck

WAC per HCPCS unit

$48.62

AWP per HCPCS unit

$58.34

Gynecologic Malignancies

Generic (brand) name

gemcitabine in 0.9% sodium chloride injection (Infugem)

Indication(s)

advanced ovarian cancer

HCPCS code/description

J9199^a-injection, Infugem, 200 mg

Manufacturer

Sun Pharmaceuticals

WAC per HCPCS unit

$76.00

AWP per HCPCS unit

$91.20

Generic (brand) name

pembrolizumab injection (Keytruda)

Indication(s)

advanced endometrial cancer; recurrent or metastatic cervical cancer

HCPCS code/description

J9271-injection, pembrolizumab 1 mg

Manufacturer

Merck

WAC per HCPCS unit

$48.62

AWP per HCPCS unit

$58.34

Hematologic Malignancies

Generic (brand) name

daratumumab injection (Darzalex)

Indication(s)

MM

HCPCS code/description

J9145-injection, daratumumab 10 mg

Manufacturer

Janssen Biotech

WAC per HCPCS unit

$55.57

AWP per HCPCS unit

$66.68

Generic (brand) name

moxetumomab pasudotox-tdfk (Lumoxiti)

Indication(s)

relapsed or refractory hairy-cell leukemia

HCPCS code/description

J9313-injection, moxetumomab pasudotox-tdfk, 0.01 mg

Manufacturer

AstraZeneca

WAC per HCPCS unit

$21.15

AWP per HCPCS unit

$25.37

Generic (brand) name

nivolumab injection (Opdivo)

Indication(s)

classical HL

HCPCS code/description

J9299-injection, nivolumab 1 mg

Manufacturer

Bristol Myers Squibb

WAC per HCPCS unit

$27.42

AWP per HCPCS unit

$32.90

Generic (brand) name

pembrolizumab injection (Keytruda)

Indication(s)

classical HL; primary mediastinal large B-cell lymphoma

HCPCS code/description

J9271-injection, pembrolizumab 1 mg

Manufacturer

Merck

WAC per HCPCS unit

$48.62

AWP per HCPCS unit

$58.34

Generic (brand) name

rituximab-abbs injection (Truxima)

Indication(s)

CLL; NHL

HCPCS code/description

Q5115-injection Truxima 10 mg

Manufacturer

Cephalon

WAC per HCPCS unit

$84.56

AWP per HCPCS unit

$101.47

Generic (brand) name

rituximab and hyaluronidase, human recombinant (Rituxan Hycela)

Indication(s)

CLL; DLBCL; FL

HCPCS code/description

J9311-injection rituximab, hyaluronidase 10 mg

Manufacturer

Genentech

WAC per HCPCS unit

$46.98

AWP per HCPCS unit

$56.37

^aDeactivation date for HCPCS code J9199 (Infugem 200 mg) is June 30, 2020. Activation date for HCPCS code J9198 (Infugem 100 mg) is July 1, 2020.

AWP indicates average wholesale price; CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; HCPCS; Healthcare Common Procedure Coding System; HL, Hodgkin lymphoma; MBC, metastatic breast cancer; MM, multiple myeloma; NHL, non-Hodgkin lymphoma; NSCLC, non–small-cell lung cancer; SCLC, small-cell lung cancer; WAC, wholesale acquisition cost.

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Table 2NDC Codes and Prices

Breast Cancer

Generic (brand) name

talazoparib (Talzenna) capsules

Indication(s)

locally advanced or MBC

Strength

0.25 mg

NDC code

0069-0296-30

Manufacturer

Pfizer

WAC per unit

$170.10

AWP per unit

$204.12

Generic (brand) name

talazoparib (Talzenna) capsules

Indication(s)

locally advanced or MBC

Strength

1 mg

NDC code

0069-1195-30

Manufacturer

Pfizer

WAC per unit

$510.30

AWP per unit

$612.36

Generic (brand) name

tucatinib (Tukysa) tablets

Indication(s)

MBC

Strength

50 mg

NDC code

51144-001-60

Manufacturer

Seattle Genetics

WAC per unit

$76.67

AWP per unit

$92.00

Generic (brand) name

tucatinib (Tukysa) tablets

Indication(s)

MBC

Strength

150 mg

NDC code

51144-002-12 (120 tablets)

51144-002-60 (60 tablets)

Manufacturer

Seattle Genetics

WAC per unit

$154.17

AWP per unit

$185.00

Lung Cancer

Generic (brand) name

capmatinib (Tabrecta) tablets

Indication(s)

metastatic NSCLC

Strength

150 mg

NDC code

00078-0709-56

Manufacturer

Novartis

WAC per unit

$160.27

AWP per unit

$192.32

Generic (brand) name

capmatinib (Tabrecta) tablets

Indication(s)

metastatic NSCLC

Strength

200 mg

NDC code

00078-0716-56

Manufacturer

Novartis

WAC per unit

$160.27

AWP per unit

$192.32

Generic (brand) name

dacomitinib (Vizimpro) tablets

Indication(s)

metastatic NSCLC

Strength

15 mg

NDC code

00069-0197-30

Manufacturer

Pfizer

WAC per unit

$434.00

AWP per unit

$520.80

Generic (brand) name

dacomitinib (Vizimpro) tablets

Indication(s)

metastatic NSCLC

Strength

30 mg

NDC code

00069-1198-30

Manufacturer

Pfizer

WAC per unit

$434.00

AWP per unit

$520.80

Generic (brand) name

dacomitinib (Vizimpro) tablets

Indication(s)

metastatic NSCLC

Strength

45 mg

NDC code

00069-2299-30

Manufacturer

Pfizer

WAC per unit

$434.00

AWP per unit

$520.80

Generic (brand) name

lorlatinib (Lorbrena) tablets

Indication(s)

NSCLC

Strength

25 mg

NDC code

00069-0227-01

Manufacturer

Pfizer

WAC per unit

$187.32

AWP per unit

$224.78

Generic (brand) name

lorlatinib (Lorbrena) tablets

Indication(s)

NSCLC

Strength

100 mg

NDC code

00069-0231-01

Manufacturer

Pfizer

WAC per unit

$561.95

AWP per unit

$674.34

Generic (brand) name

selpercatinib (Retevmo) capsules

Indication(s)

metastatic NSCLC

Strength

40 mg

NDC code

00002-3977-60

Manufacturer

Eli Lilly

WAC per unit

$114.44

AWP per unit

$137.33

Generic (brand) name

selpercatinib (Retevmo) capsules

Indication(s)

metastatic NSCLC

Strength

80 mg

NDC code

00002-2980-26 (120 capsules)

00002-2980-60 (60 capsules)

Manufacturer

Eli Lilly

WAC per unit

$171.67

AWP per unit

$206.00

Gynecologic Malignancies

Generic (brand) name

lenvatinib (Lenvima) capsules

Indication(s)

advanced endometrial carcinoma

Strength

4 mg

NDC code

62856-704-05 (5 per package)

62856-704-30 (30 per package)

Manufacturer

Eisai

WAC per unit

$634.03

AWP per unit

$760.34

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

8 mg/day

(4 mg × 2)

NDC code

62856-708-05 (10 per package)

62856-708-30 (60 per package)

Manufacturer

Eisai

WAC per unit

$317.02

AWP per unit

$380.42

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

10 mg/day

(10 mg × 1)

NDC code

62856-710-05 (5 per package)

62856-710-30 (30 per package)

Manufacturer

Eisai

WAC per unit

$634.03

AWP per unit

$760.84

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

12 mg/day

(4 mg × 3)

NDC code

62856-712-05 (15 per package)

62856-712-30 (90 per package)

Manufacturer

Eisai

WAC per unit

$211.34

AWP per unit

$253.61

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

14 mg/day

14 mg/day (10 mg × 1 and 4 mg × 1)

NDC code

62856-714-05 (10 per package)

62856-714-30 (60 per package)

Manufacturer

Eisai

WAC per unit

$317.02

AWP per unit

$380.42

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

18 mg/day

(10 mg × 1 and 4 mg × 2)

NDC code

62856-718-05 (15 per package)

62856-718-30 (90 per package)

Manufacturer

Eisai

WAC per unit

$211.34

AWP per unit

$253.61

Generic (brand) name

lenvatinib (Lenvima) daily dose

Indication(s)

advanced endometrial carcinoma

Strength

20 mg/day

(10 mg × 2)

NDC code

62856-720-05 (10 per package)

62856-720-30 (60 per package)

Manufacturer

Eisai

WAC per unit

$317.02

AWP per unit

$380.42

Generic (brand) name

lenvatinib (Lenvima) capsules

Indication(s)

advanced endometrial carcinoma

Strength

24 mg/day

(10 mg × 2 and 4 mg × 1)

NDC code

62856-724-05 (15 per package)

62856-724-30 (90 per package)

Manufacturer

Eisai

WAC per unit

$211.34

AWP per unit

$253.61

Generic (brand) name

rucaparib (Rubraca) tablets

Indication(s)

epithelial ovarian, fallopian tube, or primary peritoneal cancer

Strength

200 mg

NDC code

69660-201-91

Manufacturer

Clovis

WAC per unit

$139.18

AWP per unit

$167.02

Generic (brand) name

rucaparib (Rubraca) tablets

Indication(s)

epithelial ovarian, fallopian tube, or primary peritoneal cancer

Strength

250 mg

NDC code

69660-202-91

Manufacturer

Clovis

WAC per unit

$139.18

AWP per unit

$167.02

Generic (brand) name

rucaparib (Rubraca) tablets

Indication(s)

epithelial ovarian, fallopian tube, or primary peritoneal cancer

Strength

300 mg

NDC code

69660-203-91

Manufacturer

Clovis

WAC per unit

$139.18

AWP per unit

$167.02

Hematologic Malignancies

Generic (brand) name

duvelisib (Copiktra) capsules

Indication(s)

relapsed or refractory CLL; relapsed or refractory FL; relapsed or refractory SLL

Strength

15 mg

NDC code

71779-115-02

Manufacturer

Verastem

WAC per unit

$221.25

AWP per unit

$265.50

Generic (brand) name

duvelisib (Copiktra) capsules

Indication(s)

relapsed or refractory CLL; relapsed or refractory FL; relapsed or refractory SLL

Strength

25 mg

NDC code

71779-125-02

Manufacturer

Verastem

WAC per unit

$221.25

AWP per unit

$265.50

Generic (brand) name

glasdegib (Daurismo) tablets

Indication(s)

newly diagnosed AML

Strength

25 mg

NDC code

00069-0298-60

Manufacturer

Pfizer

WAC per unit

$296.19

AWP per unit

$355.43

Generic (brand) name

glasdegib (Daurismo) tablets

Indication(s)

newly diagnosed AML

Strength

100 mg

NDC code

00069-1531-30

Manufacturer

Pfizer

WAC per unit

$592.39

AWP per unit

$710.85

Generic (brand) name

gilteritinib (Xospata) tablets

Indication(s)

relapsed or refractory AML

Strength

40 mg

NDC code

00469-1425-90

Manufacturer

Astellas

WAC per unit

$262.50

AWP per unit

$315.00

Generic (brand) name

ibrutinib (Imbruvica) tablets

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

140 mg

NDC code

57962-014-28 (28 per package)

Manufacturer

Pharmacyclics

WAC per unit

$463.08

AWP per unit

$555.69

Generic (brand) name

ibrutinib (Imbruvica) capsules

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

70 mg

NDC code

57962-070-28 (28 per package)

Manufacturer

Pharmacyclics

WAC per unit

$463.08

AWP per unit

$555.69

Generic (brand) name

ibrutinib (Imbruvica) capsules

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

140 mg

NDC code

57962-140-09 (90 per package)

Manufacturer

Pharmacyclics

WAC per unit

$154.36

AWP per unit

$185.23

Generic (brand) name

ibrutinib (Imbruvica) capsules

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

140 mg

NDC code

57962-140-12 (120 per package)

Manufacturer

Pharmacyclics

WAC per unit

$154.36

AWP per unit

$185.23

Generic (brand) name

ibrutinib (Imbruvica) tablets

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

280 mg

NDC code

57962-280-28 (28 per package)

Manufacturer

Pharmacyclics

WAC per unit

$463.08

AWP per unit

$555.69

Generic (brand) name

ibrutinib (Imbruvica) tablets

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

420 mg

NDC code

57962-420-28 (28 per package)

Manufacturer

Pharmacyclics

WAC per unit

$463.08

AWP per unit

$555.69

Generic (brand) name

ibrutinib (Imbruvica) tablets

Indication(s)

CLL; MCL; MZL; SLL; WM

Strength

560 mg

NDC code

57962-560-28 (28 per package)

Manufacturer

Pharmacyclics

WAC per unit

$463.08

AWP per unit

$555.69

Generic (brand) name

ivosidenib (Tibsovo) tablets

Indication(s)

AML

Strength

250 mg

NDC code

71334-100-01

Manufacturer

Agios

WAC per unit

$457.01

AWP per unit

$548.42

Generic (brand) name

pomalidomide (Pomalyst) capsules

Indication(s)

MM

Strength

1 mg

NDC code

59572-501-00 (100 per package)

59572-501-21 (21 per package)

Manufacturer

Celgene

WAC per unit

$868.53

AWP per unit

$1042.23

Generic (brand) name

pomalidomide (Pomalyst) capsules

Indication(s)

MM

Strength

2 mg

NDC code

59572-502-00 (100 per package)

59572-502-21 (21 per package)

Manufacturer

Celgene

WAC per unit

$868.53

AWP per unit

$1042.23

Generic (brand) name

pomalidomide (Pomalyst) capsules

Indication(s)

MM

Strength

3 mg

NDC code

59572-503-00 (100 per package)

59572-503-21 (21 per package)

Manufacturer

Celgene

WAC per unit

$868.53

AWP per unit

$1042.23

Generic (brand) name

pomalidomide (Pomalyst) capsules

Indication(s)

MM

Strength

4 mg

NDC code

59572-503-00 (100 per package)

59572-503-21 (21 per package)

Manufacturer

Celgene

WAC per unit

$868.53

AWP per unit

$1042.23

AML indicates acute myeloid leukemia; AWP, average wholesale price; CLL, chronic lymphocytic leukemia; FL, follicular lymphoma; MBC, metastatic breast cancer; MCL, mantle-cell lymphoma; MM, multiple myeloma; MZL, marginal zone lymphoma; NDC, National Drug Code; NSCLC, non–small-cell lung cancer; SLL, small lymphocytic lymphoma; WAC, wholesale acquisition cost; WM, Waldenström’s macroglobulinemia.

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Drugs Used for the Treatment of Select Malignancies and Their Associated Codes and Pricing

Table 1HCPCS Codes and Prices

Breast Cancer

Lung Cancer

Gynecologic Malignancies

Hematologic Malignancies

Table 2NDC Codes and Prices

Breast Cancer

Lung Cancer

Gynecologic Malignancies

Hematologic Malignancies

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Drugs Used for the Treatment of Select Malignancies and Their Associated Codes and Pricing

Table 1HCPCS Codes and Prices

Breast Cancer

Lung Cancer

Gynecologic Malignancies

Hematologic Malignancies

Table 2NDC Codes and Prices

Breast Cancer

Lung Cancer

Gynecologic Malignancies

Hematologic Malignancies

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