C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Albiglutide for SQ injection (Tanzeum™) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Metreleptin for injection (Myalept ™) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Pasireotide (Signifor®) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Interferon beta 1a, Rebif ® |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Exenatide XR, Bydureon®
|
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Cosentyx (Secukinumab) subcutaneous use* |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Praluent® (Alirocumab) |
11/24/2015 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Repatha™ (Evolucumab) |
11/24/2015 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Dulaglutide, Trulicity® |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Methotrexate - Solution Auto-injector Non Chemotherapeutic, Otrexup™, Rasuvo® |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Parathyroid Hormone, Natpara® |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Peginterferon beta-1a, Plegridy™ |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
All insulin products |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Exenatide Byetta® |
06/27/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Etanercept-SZZS (Erelzi™) |
12/06/2016 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Asfotase-alfa (Strensiq™) |
02/28/2017 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Ixekizumab (Taltz™) |
02/28/2017 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-atto (Amjevita™) |
02/28/2017 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Dupilumab (Dupixent) |
08/07/2017 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Brodalumab (Siliq) |
08/07/2017 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Sogroya® (somapacitan-beco) |
04/05/2021 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Ropeginterferon alfa-2b-njft (Besremi®) |
04/24/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Risankizumab-rzaa (Skyrizi™) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/17/2022 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adbry™ (tralokinumab-ldrm) |
11/01/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Mounjaro™ (Tirzepatide) |
11/19/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-aacf (Idacio®) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-afzb (Abrilada™) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-bwwd (Hadlima) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-fkjp (Hulio®) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-adaz (Hyrimoz) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-aqvh (Yusimry) |
06/25/2023 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Vedolizumab (Entyvio®) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adalimumab-aaty (Yuflyma) |
01/14/2024 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Mirikizumab-mrkz (Omvoh™) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J0129 |
INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Orencia® subcutaneous use* |
04/05/2021 |
N/A |
Apparent on its Face |
J0135 |
INJECTION, ADALIMUMAB, 20 MG |
Humira® |
11/01/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0270 |
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Alprostadil®, Caverject®, Edex®, Prostin VR Pediatric® |
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0364 |
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG |
Apokyn® |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0593 |
INJECTION, LANADELUMAB-FLYO, 1 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF-ADMINISTERED) |
lanadelumab-flyo (TAKHZYRO) |
12/02/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0599 |
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITS |
HAEGARDA® |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0630 |
INJECTION, CALCITONIN SALMON, UP TO 400 UNITS |
Calcimar®, Miacalcin, Osteocalcin, Salmonine, Fortical
|
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J0801 |
INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITS |
H.P. Acthar® Gel subcutaneous use* |
10/01/2023 |
N/A |
Apparent on its Face |
J0802 |
INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITS |
H.P. Acthar® Gel subcutaneous use* |
10/01/2023 |
N/A |
Apparent on its Face |
J1324 |
INJECTION, ENFUVIRTIDE, 1 MG |
Fuzeon® |
05/01/2004 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1438 |
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Enbrel® |
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1595 |
INJECTION, GLATIRAMER ACETATE, 20 MG |
Copaxone® |
05/01/2004 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1628 |
INJECTION, GUSELKUMAB, 1 MG |
Tremfya® (guselkumab) |
05/15/2021 |
N/A |
Acceptable Evidentiary Criteria Available |
J1675 |
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS |
Supprelin LA® |
07/15/2006 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1744 |
INJECTION, ICATIBANT, 1 MG |
Icatibant (Firazyr®) |
07/31/2012 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1811 |
INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
Fiasp® |
08/20/2023 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1812 |
INSULIN (FIASP), PER 5 UNITS |
Fiasp® |
08/20/2023 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1813 |
INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
Lyumjev® |
08/20/2023 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1814 |
INSULIN (LYUMJEV), PER 5 UNITS |
Lyumjev® - 100 IU* |
08/20/2023 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1814 |
INSULIN (LYUMJEV), PER 5 UNITS |
Lyumjev® - 200 IU |
08/20/2023 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1815 |
INJECTION, INSULIN, PER 5 UNITS |
All insulin products |
11/01/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1817 |
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
All insulin products
|
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J1830 |
INJECTION, INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Betaseron® |
01/15/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J1941 |
INJECTION, FUROSEMIDE (FUROSCIX), 20 MG |
furosemide (Furoscix®) |
08/20/2023 |
N/A |
Apparent on its Face |
J2170 |
INJECTION, MECASERMIN, 1 MG |
Increlex®, Iplex |
04/15/2007 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J2212 |
INJECTION, METHYLNALTREXONE, 0.1 MG |
Relistor® |
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J2354 |
INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG |
Octreotide Acetate, Sandostatin*
|
10/15/2005 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J2440 |
INJECTION, PAPAVERINE HCL, UP TO 60 MG |
Papaverine HCL
|
11/01/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J2940 |
INJECTION, SOMATREM, 1 MG |
Protropin® |
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J2941 |
INJECTION, SOMATROPIN, 1 MG |
Humatrope, Genotropin, Omnitrope, Saizen, Zorbtive, Zomacton, Norditropin, Nutropin
|
01/15/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J3030 |
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Imitrex® |
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3031 |
INJECTION, FREMANEZUMAB-VFRM, 1 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF-ADMINISTERED) |
Fremanezumab-vfrm (Ajovy) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3110 |
INJECTION, TERIPARATIDE, 10 MCG |
Forteo® |
11/01/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3355 |
INJECTION, UROFOLLITROPIN, 75 IU |
Metrodin®, Bravelle®, Fertinex® |
04/15/2007 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3357 |
USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG |
Stelara® |
10/15/2021 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Peginterferon Alfa 2-b, Sylatron, Pegintron |
06/26/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Kynamro® (mipomersen sodium) |
06/26/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Pramlintide acetate, Symlin®, SymlinPen 60, SymlinPen 120
|
04/01/2006 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Exenatide Byetta® |
04/01/2006 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Tesamorelin Acetate, Egrifta®
|
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Trimix |
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Liraglutide GLP-1, Victoza® , Saxenda® |
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Albiglutide for SQ injection (Tanzeum™) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Metreleptin for injection (Myalept™) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Pasireotide (Signifor®) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Interferon beta 1a, (Rebif®) |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Exenatide XR, Bydureon® |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Cosentyx (Secukinumab) subcutaneous use* |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
All insulin products |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-adbm (Cyltezo) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Sogroya® (somapacitan-beco) |
04/05/2021 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Ropeginterferon alfa-2b-njft (Besremi®) |
04/24/2022 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Risankizumab-rzaa (Skyrizi™) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/17/2022 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Adbry™ (tralokinumab-ldrm) |
11/01/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Mounjaro™ (Tirzepatide) |
11/01/2022 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-aqvh (Yusimry) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-adaz (Hyrimoz) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-fkjp (Hulio®) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-bwwd (Hadlima) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-afzb (Abrilada™) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-aacf (Idacio®) |
06/25/2023 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Mirikizumab-mrkz (Omvoh™) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adalimumab-aaty (Yuflyma) |
01/14/2024 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Vedolizumab (Entyvio®) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Vedolizumab (Entyvio®) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-aaty (Yuflyma) |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Mirikizumab-mrkz (Omvoh™) subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-aacf (Idacio®) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-afzb (Abrilada™) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-bwwd (Hadlima) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-fkjp (Hulio®) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-adaz (Hyrimoz) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-aqvh (Yusimry) |
06/25/2023 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Mounjaro™ (Tirzepatide) |
11/19/2022 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adbry™ (tralokinumab-ldrm) |
11/01/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J3590 |
UNCLASSIFIED BIOLOGICS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/17/2022 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Risankizumab-rzaa (Skyrizi™) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
J3590 |
UNCLASSIFIED BIOLOGICS |
Ropeginterferon alfa-2b-njft (Besremi®) |
04/24/2022 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Sogroya® (somapacitan-beco) |
04/05/2021 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Abaloparatide (Tymlos) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Sarilumab (Kevzara) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Semaglutide (Ozempic) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Erenumab-aoooe (Aimovig) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Alcanezumab-gnlm (Emgality) |
09/18/2019 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Praluent® (Alirocumab) |
11/24/2015 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Repatha™ (Evolucumab) |
11/24/2015 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Dulaglutide, Trulicity® |
06/27/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Methotrexate - Solution Auto-injector Non Chemotherapeutic, Otrexup™, Rasuvo® |
06/27/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Parathyroid Hormone, Natpara® |
06/27/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Peginterferon beta-1a, Plegridy™ |
06/27/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
All insulin products |
06/27/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Pegvisomant Somavert®, variable |
05/01/2004 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Peginterferon Alfa-2a, Pegasys™, Roferon®-A
|
05/01/2005 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Anakinra (Kineret®) |
10/15/2005 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Golimumab, Simponi® |
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Abatacept Orencia®
|
09/30/2013 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Etanercept-SZZS (Erelzi™) |
12/06/2016 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Asfotase-alfa (Strensiq™) |
02/28/2017 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Ixekizumab (Taltz™) |
02/28/2017 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adalimumab-atto (Amjevita™) |
02/28/2017 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Dupilumab (Dupixent) |
08/07/2017 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Brodalumab (Siliq) |
08/07/2017 |
N/A |
Apparent on its Face |
J9212 |
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM |
Infergen® |
11/01/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J9213 |
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS |
Roferon-A® |
11/01/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J9216 |
INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS |
Actimmune® |
01/15/2003 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
J9218 |
LEUPROLIDE ACETATE, PER 1 MG |
Leuprolide Acetate, Leuprolide Acetate Inj
|
01/15/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration|Acceptable Evidentiary Criteria Available |
Q0515 |
INJECTION, SERMORELIN ACETATE, 1 MICROGRAM |
Geref®
|
04/15/2007 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
Q3027 |
INJECTION, INTERFERON BETA-1A, 1 MCG FOR INTRAMUSCULAR USE |
Avonex®, Avonex Pen®
|
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
Q3028 |
INJECTION, INTERFERON BETA-1A, 1 MCG FOR SUBCUTANEOUS USE |
Rebif® |
06/04/2015 |
N/A |
Apparent on its Face|Presumption of Long-Term Non-Acute Administration |
Q5131 |
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 20 MG |
Adalimumab-aacf (Idacio®) |
07/01/2023 |
N/A |
Apparent on its Face |