Specialty drugs by HCPCS code

Every drug in the library, sorted by J-code then Q-code. Searching for a specific HCPCS? Use the search box — it matches codes, drug names, and indications. View alphabetical ›

🔍 188 drugs

Billing reference library

When a drug page says "use JW modifier" or "bill 96413," the deep-dive is one click away. Sourced from CMS IOM, AMA CPT, NCCI edits, MAC LCDs, and payer policy documents.

Modifier reference ›

JW · JZ · JG/TB (340B) · KX · GA/GZ/GY (ABN) · RT/LT/E1-E4 (eye) · biosimilar suffix conventions

CPT admin codes ›

96365/66 IV biologics · 96413/15 chemo · 96417 sequential push · 96369/71 SCIG · 96360/61 hydration · 67028 intravitreal

Payer playbooks ›

UnitedHealthcare · Aetna · Cigna · Humana — PA workflows, portals, fax numbers, biosimilar mandates, denials, reauth

RA, JIA, PsA, aGVHD prevention

IV Antivirals Reference

acyclovir + ganciclovir + 6 more (rollup)

J0133 J1570 J1455 J0740

IV antivirals rollup (excl. Veklury) — acyclovir anchor (J0133); CMV in transplant focus; foscarnet nephrotoxicity; cidofovir highest-cost

Humira / biosimilars

adalimumab + Amjevita, Cyltezo, Hadlima, Hyrimoz

J0135 Q5131 Q5126

RA, PsA, AS, Crohn's, UC, plaque psoriasis

Early symptomatic Alzheimer's (q2wk anti-amyloid IV)

Early symptomatic Alzheimer's (q4wk anti-amyloid IV)

aflibercept (8 mg high-dose)

wAMD, DME, DR, RVO (high-dose formulation)

wAMD, DME, RVO, mCNV

brolucizumab-dbll

agalsidase beta

Fabry disease ERT (IV q2wk)

Relapsing forms of MS

olipudase alfa-rpcp

ASMD / Niemann-Pick type B + A/B (first-in-class IV q2wk)

hATTR-PN (IV q3wk siRNA)

Acute hepatic porphyria attack reduction (SC monthly siRNA)

hATTR-PN + ATTR-CM (SC q3mo siRNA, HELIOS-B 2025)

COVID-19 antiviral (IV; 5-day inpatient or 3-day outpatient; inpatient typically DRG-bundled)

IV Antifungals Reference

AmBisome + caspofungin + 10 more (rollup)

J0289 J0637 J2248 J0348

IV antifungals rollup — AmBisome anchor (J0289); 3 classes (polyenes, echinocandins, azoles); ID consult + biomarker gates (galactomannan, BD-glucan)

belatacept (CTLA-4-Ig)

Kidney transplant rejection prophylaxis (EBV-seropositive REMS; 10 mg/kg initial 6 doses → 5 mg/kg q4w maintenance; J0485 = 1 mg/unit; NOT for liver transplant per boxed warning)

SLE + lupus nephritis (anti-BAFF IV q4wk; pediatric ≥5 yr)

anifrolumab-fnia

Moderate-severe SLE (anti-IFN-α/β receptor IV q4wk)

Severe eos asthma, EGPA (q4wk×3 → q8wk SC)

cerliponase alfa (recombinant TPP1 ICV ERT)

CLN2 disease / Batten ≥3 yr (FIRST CLN2 treatment; BioMarin; intracerebroventricular via Ommaya reservoir; CPT 96450 NOT 96365; 300 mg q2w; ~$702K/yr)

Bivalirudin / Angiomax

bivalirudin (multi-generic; Angiomax)

Direct thrombin inhibitor for PCI ± HIT (defensive content — J0583 is OPPS SI=N packaged + MS-DRG bundled; NOT separately payable in PCI; titrated to ACT 300-350 sec)

X-linked hypophosphatemia + tumor-induced osteomalacia (anti-FGF23 SC)

lanadelumab-flyo

HAE prophylaxis (SC q2-4wk mAb)

C1 esterase inhibitor recombinant

HAE acute attack treatment (IV on-demand, recombinant)

C1 esterase inhibitor (human)

HAE acute attack treatment (IV on-demand)

C1 esterase inhibitor (human)

HAE prophylaxis (IV q3-4d, plasma-derived)

C1 esterase inhibitor SC (human)

HAE prophylaxis (SC q3-4d, plasma-derived)

Periodic fever syndromes (CAPS, SJIA, AOSD, TRAPS, HIDS-MKD, FMF) — anti-IL-1β SC q4-8w; J0638 = 1 mg/unit; genetic testing PA gate (NLRP3/MEFV/MVK/TNFRSF1A)

certolizumab pegol

RA, PsA, AS, axSpA, plaque psoriasis, Crohn's

corticotropin (repository)

MS exacerbations, infantile spasms, multiple rheum/derm/renal indications (SC/IM)

Legacy Direct Thrombin Inhibitors

desirudin + lepirudin + fondaparinux (rollup)

Legacy DTIs rollup — desirudin anchor (J0838, not in CMS ASP); lepirudin withdrawn 2012; Fondaparinux CONTRAINDICATED in HIT

Low/int-1 MDS post-ESA failure (telomerase inhibitor IV q4w; 7.1 mg/kg actual weight)

darbepoetin alfa

Long-acting ESA (CKD anemia + CIA; non-ESRD vs ESRD codes)

argatroban (multi-generic; Acova discontinued)

J0883 J0884 J0891 J0892 J0898 J0899

HIT-specific direct thrombin inhibitor (continuous IV titrated to aPTT 1.5-3× baseline; J0883 non-ESRD vs J0884 ESRD on dialysis — RENAL STATUS split, not payer; J0891/J0892 Accord + J0898/J0899 Auromedics non-equivalent codes)

Epogen / Procrit

Short-acting ESA (CKD anemia, CIA, surgery, HIV)

methoxy PEG-epoetin beta

CKD-only ESA (q4wk longest-acting; CKD-only positioning)

luspatercept-aamt

Beta-thalassemia + MDS transfusion-dependent anemia (SC)

Prolia / Jubbonti + biosimilars

denosumab + Jubbonti, Stoboclo

J0897 Q5136 Q5157 Q5158

Postmenopausal osteoporosis + AI/ADT-induced bone loss (60 mg SC q6mo; vs Xgeva 120 mg q4wk for cancer SREs)

Xgeva + biosimilars

denosumab cancer-dose + Jubbonti, Wyost, Stoboclo

J0897 Q5136 Q5157 Q5158

Cancer-related SREs in solid tumor bone mets + MM + GCTB (denosumab 120 mg SC q4w; CPT 96372; distinct from Prolia 60 mg q6mo postmenopausal — same molecule, different brand/dose/J-code)

Soliris / biosimilars

eculizumab + Epysqli, Bkemv

J1299 Q5151 Q5152

PNH, aHUS, gMG, NMOSD

ravulizumab-cwvz

PNH, aHUS, gMG, NMOSD

crovalimab-akkz (anti-C5)

PNH ≥13 yr ≥40 kg (anti-C5 mAb; weight-banded loading + SC q4wk maintenance; J1307 = 10 mg/unit; PIASKY REMS SEPARATE from Soliris/Ultomiris REMS)

elosulfase alfa

MPS IVA (Morquio A) ERT (IV weekly)

elranatamab-bcmm

R/R multiple myeloma (BCMA×CD3 SC bispecific, REMS)

zolbetuximab-clzb (anti-claudin 18.2)

HER2-neg CLDN18.2+ gastric/GEJ 1L (first claudin 18.2 mAb, Astellas; VENTANA CLDN18 ≥75% 2+/3+ IHC required; combo with mFOLFOX6 or CAPOX; ~$5-7K/dose)

etranacogene dezaparvovec-drlb

Adult hemophilia B (one-time AAV5 IV gene therapy, CSL Behring; AAV5 NAb <1:678 gate; world's most expensive drug at ~$3.5M)

ferric derisomaltose

IDA (IV, 1,000 mg single-dose course)

ferric carboxymaltose

IDA (IV, 750 mg ×2; HF + pediatric expansions)

Neupogen + biosimilars

filgrastim + Zarxio, Nivestym, Releuko, Nypozi

J1442 Q5101 Q5110 Q5125

Chemo-induced neutropenia, BMT (G-CSF SC daily, weight-based; J1442 = 1 mcg/unit)

MPS VI (Maroteaux-Lamy) ERT (IV weekly)

immune globulin IV 10% (CSL)

immune globulin SC 16.5% (Octapharma)

PI (SCIG, only 16.5% concentration)

immune globulin IV 10% (GC Biopharma)

PI (lowest IgA content — IgA-deficient niche)

immune globulin SC 20% (Takeda)

PI (SCIG via pump)

immune globulin SC 20% (Grifols)

PI (SCIG via pump)

immune globulin SC 20% (CSL)

PI, CIDP maintenance (SCIG via pump)

Gamunex-C / Gammaked

immune globulin IV 10% (Grifols / Kedrion)

PI, ITP, CIDP (IV + SC)

immune globulin IV 5% / 10% (Octapharma)

PI, ITP, dermatomyositis (10%)

Gammagard Liquid

immune globulin IV 10% (Takeda)

PI, MMN, off-label CIDP / SID

RA, PsA, AS, polyarticular JIA

Tremfya (IV induction)

Crohn's + UC IV induction (IL-23) + psoriasis/PsA SC

MPS II (Hunter) ERT (IV weekly)

Remicade / biosimilars

infliximab + Inflectra, Renflexis, Avsola

J1745 Q5103 Q5104 Q5121

RA, AS, PsA, psoriasis, Crohn's, UC

IDA (IV, requires test dose; Boxed)

IDA in CKD (IV, HDD-CKD bundled into ESRD PPS)

Type 1 Gaucher disease ERT (IV)

inebilizumab-cdon

NMOSD AQP4-IgG+ (2020) + IgG4-RD (2025) (anti-CD19 mAb; 300 mg D1+D15 loading → q6mo maintenance; J1823 = 1 mg/unit; $148K/dose)

Somatuline Depot

lanreotide acetate (deep SC depot)

Acromegaly + GEP-NETs + carcinoid syndrome (SSA depot deep SC q4w; CPT varies by indication 96372/96401)

MPS I (Hurler/Hurler-Scheie/Scheie) ERT (IV weekly)

leuprolide acetate (long-acting depot)

Prostate cancer, endometriosis, fibroids, central precocious puberty

Severe eos asthma, EGPA, HES, CRSwNP (anti-IL-5 SC)

mirikizumab-mrkz

Ulcerative colitis + Crohn's disease (anti-IL-23p19; 300 mg IV q4w × 3 induction → 200 mg SC q4w maintenance; SC CAN bill medical under J2267, distinct from Skyrizi/Tremfya SC pharmacy-only)

RRMS, Crohn's disease

nusinersen (intrathecal ASO)

SMA all types + ages (intrathecal LP via CPT 62321 — NOT 96365; loading + q4mo maintenance; SMN1 confirmation; Biogen Above SMA)

Skyrizi (IV induction)

risankizumab-rzaa

Crohn's + UC IV induction (IL-23, → SC maintenance)

ublituximab-xiiy

Relapsing forms of MS (RRMS, active SPMS, CIS — not PPMS)

ocrelizumab (IV)

RRMS, PPMS, SPMS

ocrelizumab and hyaluronidase-ocsq (SC)

RRMS, PPMS, SPMS (subcutaneous)

Sandostatin / LAR Depot

octreotide acetate

Acromegaly + carcinoid + NETs (SC non-depot vs IM LAR depot)

tezepelumab-ekko

Severe persistent asthma add-on regardless of phenotype (anti-TSLP class-of-one; 210 mg SC q4w; no biomarker gate)

Allergic asthma, CSU, CRSwNP, food allergy (anti-IgE SC)

Neulasta + biosimilars

J2506 Q5108 Q5111 Q5120 Q5122 Q5125

Long-acting G-CSF for chemo-induced neutropenia prevention

pegunigalsidase alfa-iwxj

Fabry disease ERT (IV q2wk PEGylated; vs Fabrazyme J0180)

IV Anesthesia & Sedation Reference

propofol + midazolam + fentanyl + 9 more (rollup)

J2704 J2250 J3010

IV anesthesia/sedation rollup — propofol anchor (J2704); USUALLY BUNDLED into 00xxx anesthesia time / APC packaging / ICU per-diem; J0480 ≠ flumazenil (= basiliximab), J2786 ≠ sugammadex (= reslizumab)

Lucentis / biosimilars

ranibizumab + Byooviz, Cimerli

wAMD, DME, RVO, mCNV, ROP

Severe eosinophilic asthma (IV, eos ≥400)

sebelipase alfa

LAL-D / Wolman disease + CESD (lysosomal ERT; Wolman 1-3 mg/kg weekly, CESD 1 mg/kg q2w; LAL enzyme assay required; Wolman → Medicaid-primary)

Solu-Medrol + generics

methylprednisolone sodium succinate IV

Chemo premed, MS pulse (1g×3-5d), transplant rejection, severe asthma, anaphylaxis (NOT chemo — 96365/96374 not 96413; J2919 = 5 mg/unit)

eptinezumab-jjmr

Migraine prevention (episodic + chronic)

talquetamab-tgvs

R/R multiple myeloma (GPRC5D×CD3 SC bispecific, REMS)

taliglucerase alfa

Type 1 Gaucher ERT (IV q2w, 60 units/kg; first FDA plant-cell expressed therapeutic; J3060 = 10 units/billing unit)

romosozumab-aqqg

Postmenopausal osteoporosis high fracture risk (sclerostin inhibitor; 210 mg monthly = 2 × 105 mg SC = 96372 × 2; BOXED CV warning; max 12 monthly doses then transition to antiresorptive)

teprotumumab-trbw

Thyroid Eye Disease (IGF-1R inhibitor; 8-infusion course 10→20 mg/kg q3w; CAS ≥3 required; J3241 = 10 mg/unit; ~$423K course total)

PsA, AS, plaque psoriasis

Actemra / biosimilars

tocilizumab + Tofidence, Tyenne, Avtozma

RA, JIA, GCA, CRS, COVID, SSc-ILD

Stelara / biosimilars

ustekinumab + Wezlana, Selarsdi, +more

J3357 J3358 Q5137 Q5138

PsA, plaque psoriasis, Crohn's, UC

IV Antibiotics Reference

vancomycin + daptomycin + 13 more (rollup)

J3370 J3373 J0878 J2020 J0714 J2186

HOPD/OPAT IV antibiotics rollup — vancomycin anchor (J3370/J3373); MRSA/VRE/CRE/CRAB landscape; OPAT PA gates

UC, Crohn's disease

velaglucerase alfa

Type 1 Gaucher ERT (IV q2w, 60 units/kg; J3385 = 100 units/billing unit)

valoctocogene roxaparvovec-rvox

Adult severe hemophilia A (one-time AAV5 IV gene therapy, BioMarin; AAV5 NAb-negative + no FVIII inhibitor history required; ~$2.9M)

onasemnogene abeparvovec-xioi

Pediatric SMA ≤2 yr (one-time AAV9 IV gene therapy, Novartis; AAV9 antibody titer <1:50 gate; outcomes-based contracting; ~$2.125M)

IV Vitamins & Supplements Reference

B12 + vitamin K + thiamine + 7 more (rollup)

J3420 J3430 J3411 J1610 J1955

IV vitamins/supplements rollup — cyanocobalamin/B12 anchor (J3420); B12 IM vs IV trap; J0640 = leucovorin (NOT plain folate); TPN bundling defensive framing

vosoritide (CNP analog)

Pediatric achondroplasia ≥4 mo with open growth plates (BioMarin; weight-based daily SC; FGFR3 mutation + open growth plates required; ~$320K/yr)

bimekizumab-bkzx (IL-17A/F)

Plaque psoriasis + PsA + AS + HS (dual IL-17A/F vs Cosentyx/Taltz IL-17A-only; UCB; SC q4w → q8w psoriasis, q4w PsA/AS/HS; pharmacy benefit dominant)

exagamglogene autotemcel (exa-cel)

SCD + TDT ≥12 yr (one-time CRISPR-edited autologous HSC, Vertex/CRISPR Tx; multi-stage encounter; ATC-restricted; ~$2.2M)

lovotibeglogene autotemcel (lovo-cel)

SCD ≥12 yr only — NO TDT (one-time lentiviral autologous HSC, Bluebird Bio; BOXED hematologic malignancy warning; QTC-restricted; ~$3.1M)

IV Fluids & Electrolytes Reference

NS + LR + D5W + KCl + Mg + Ca + 6 more (rollup)

J7030 J7040 J7050 J7120 J7070

IV fluids + electrolytes rollup — NS anchor (J7030); 96360/96361 hydration vs 96365/96366 drug-admin trap; chemo-vehicle bundling rules

andexanet alfa (Factor Xa decoy)

Emergency reversal of apixaban/rivaroxaban anticoagulation (NOT edoxaban, NOT dabigatran→Praxbind); ED single-encounter; low/high dose stratification; BOXED thrombotic warning

emicizumab-kxwh

Hemophilia A prophylaxis (both inhibitor + non-inhibitor; FVIII bispecific SC weekly/q2w/q4w; J7170 = 0.5 mg/unit; cheaper per unit than Alhemo; Feiba/aPCC boxed warning)

concizumab-mtci

Hemophilia A/B prophylaxis incl. inhibitors (SC daily, anti-TFPI; J7173 = 0.5 mg/unit)

doxorubicin (multi-generic; Adriamycin)

Breast (AC), DLBCL (R-CHOP), Hodgkin (ABVD), AML, sarcoma (anthracycline; vesicant; 450-550 mg/m² lifetime cardiac cap; distinct from Doxil Q2050)

datopotamab deruxtecan-dlnk

HR+/HER2- mBC + EGFR+ NSCLC (TROP-2 ADC q3w; use D5W diluent)

NSCLC, SCLC, HCC, urothelial, TNBC, melanoma, sarcoma

bendamustine HCl (premixed)

CLL, indolent NHL, MCL (10-min infusion vs Treanda J9033)

Avastin / biosimilars

bevacizumab + Mvasi, Zirabev, Alymsys, Vegzelma, Avzivi

J9035 Q5107 Q5118 Q5126 Q5129 Q5145

mCRC, NSCLC, GBM, RCC, cervical, ovarian, HCC

bortezomib + Boruzu, generic

J9041 J9054 J9049

Multiple myeloma + MCL (proteasome inhibitor SC/IV)

brentuximab vedotin

Hodgkin lymphoma, ALCL, PTCL, CTCL (anti-CD30 ADC)

carboplatin (multi-generic; Paraplatin discontinued)

Ovarian, NSCLC, SCLC, HNSCC, bladder (2nd-gen platinum; Calvert formula AUC × [GFR+25]; J9045 = 50 mg/unit)

R/R multiple myeloma (2nd-gen proteasome inhibitor IV)

cisplatin (multi-generic; Platinol discontinued)

HNSCC, NSCLC, SCLC, ovarian, bladder, testicular GCT (1st-gen platinum; aggressive hydration; preserved multi-dose vial — NO JW/JZ; J9060 = 10 mg/unit)

Generic IV Chemotherapy Reference

cyclophosphamide + 5-FU + cytarabine + 15 more (rollup)

J9070 J9190 J9100 J9208 J9209

Generic IV chemo rollup (long-tail, NOT in dedicated pages) — cyclophosphamide anchor (J9070); multi-dose vial JZ/JW exclusion; 96416 vs 96417 portable pump trap

cemiplimab-rwlc

Cutaneous SCC (1st FDA), BCC, NSCLC, cervical

Darzalex Faspro

daratumumab + hyaluronidase-fihj (SC)

Multiple myeloma, AL amyloidosis (SC formulation)

daratumumab (IV)

Multiple myeloma, AL amyloidosis

Advanced prostate cancer (GnRH antagonist, no flare)

NSCLC (PACIFIC), SCLC (ADRIATIC), HCC, biliary, urothelial, endometrial

Relapsed/refractory multiple myeloma

enfortumab vedotin-ejfv

Locally advanced/metastatic urothelial cancer (Keytruda combo 1L + post-platinum mono)

gemcitabine (Gemzar + generics)

Pancreatic, NSCLC, breast, ovarian, bladder, biliary

gemtuzumab ozogamicin

CD33+ AML newly diagnosed + R/R (anti-CD33 ADC with calicheamicin payload; fractionated D1/D4/D7 induction; J9203 = 0.1 mg/unit; BOXED hepatotoxicity/VOD)

mogamulizumab-kpkc

R/R cutaneous T-cell lymphoma — MF/Sézary (anti-CCR4 mAb; 1 mg/kg q1w × 4 → q2w; J9204 = 1 mg/unit; W&P-level warnings, not boxed)

irinotecan liposomal (pegylated)

Metastatic pancreatic adenocarcinoma (NALIRIFOX 1L 2024)

irinotecan (multi-generic; Camptosar)

CRC (FOLFIRI/FOLFIRINOX), pancreatic, gastric (topo-I inhibitor q2w; UGT1A1*28 dose-adjust; J9206 = 20 mg/unit; distinct from Onivyde J9205)

emapalumab-lzsg

Primary HLH + 2025 Still's-MAS sBLA (anti-IFN-γ mAb; 1 mg/kg q3d escalating to 10 mg/kg; PICU induction DRG-bundled, outpatient bridge-to-HSCT Part B; HLH-2004 criteria gate)

isatuximab-irfc

Multiple myeloma (anti-CD38, IMROZ 1L 2024)

Melanoma, RCC, MSI-H/dMMR CRC, HCC, NSCLC, esoph, mesothelioma (Opdivo combos)

inotuzumab ozogamicin

R/R B-cell precursor ALL (anti-CD22 ADC, calicheamicin payload)

oxaliplatin (Eloxatin + generics)

CRC (FOLFOX), gastric (FLOT), pancreatic (FOLFIRINOX)

paclitaxel protein-bound (nab-paclitaxel)

Metastatic breast, NSCLC (combo), pancreatic adenocarcinoma (combo)

paclitaxel conventional (multi-generic; Taxol)

Breast, ovarian, NSCLC, HNSCC (3-hr IV with premed; Cremophor vehicle + in-line filter; multi-dose vial JZ-default; distinct from Abraxane J9264)

Multiple solid tumor & hematologic indications

dostarlimab-gxly

dMMR/MSI-H endometrial (RUBY 1L), tumor-agnostic dMMR

tisotumab vedotin-tftv

Recurrent/metastatic cervical cancer (anti-tissue-factor ADC)

zanidatamab-hrii

HER2+ biliary tract cancer (HER2/HER2 bispecific, Jazz; J9276 = 2 mg/unit; replaced C9302)

pembrolizumab + berahyaluronidase alfa (SC)

Most Keytruda IV indications (SC formulation, 395 mg q3w or 790 mg q6w)

glofitamab-gxbm

R/R DLBCL (CD20×CD3 IV bispecific, fixed 12-cycle)

nivolumab + hyaluronidase-nvhy (SC)

Most Opdivo solid tumor indications (SC formulation; J9289 = 2 mg/unit)

nivolumab + relatlimab-rmbw

Unresectable/metastatic melanoma 1L (first-in-class LAG-3 + PD-1 fixed-dose combo; 480/160 mg q4w; J9298 = 3 mg nivo + 1 mg rela/unit; distinct from Opdivo J9299 + Opdivo Qvantig J9289)

Melanoma, NSCLC, RCC, others

CLL 1L + FL (post-rituximab) + Columvi pretreatment Day -7 (anti-CD20 Type II glycoengineered; HBV screen mandatory; 1000 mg flat dose; J9301 = 10 mg/unit)

mCRC RAS-WT (anti-EGFR; companion diagnostic gate; 6 mg/kg q2w; J9303 = 10 mg/unit; distinct from Erbitux — no premed required)

pemetrexed (Alimta + generics)

Non-squamous NSCLC, mesothelioma (vitamin supp + CrCl)

HER2+ breast cancer (combo with Herceptin)

Gastric/GEJ + NSCLC + mCRC + HCC (anti-VEGFR2; indication-specific dosing 8-10 mg/kg; HCC requires AFP ≥400; J9308 = 5 mg/unit)

polatuzumab vedotin-piiq

DLBCL 1L (POLARIX with R-CHP) + R/R DLBCL

Rituxan / biosimilars

rituximab + Ruxience, Truxima, Riabni

J9312 Q5119 Q5115

NHL, CLL, RA, GPA/MPA

pertuzumab + trastuzumab + hyaluronidase-zzxf (SC)

HER2+ breast cancer (SC fixed-dose combo Q3W; J9316 = 10 mg pertuzumab/unit; CPT 96401; distinct from Perjeta J9306 + Herceptin J9355 IV components)

sacituzumab govitecan-hziy

Metastatic TNBC, HR+/HER2- metastatic breast, urothelial

epcoritamab-bysp

R/R DLBCL, FL (CD20×CD3 SC bispecific)

Emrelis (Teliso-V)

telisotuzumab vedotin-tllv

c-MET HIGH overexpression NSCLC post-systemic therapy (c-MET ADC q2w; VENTANA MET SP44 IHC ≥50%)

tislelizumab-jsgr

ESCC + HER2-neg G/GEJ (PD-1 IV q3w; NSCLC EU/China only, not US label)

Vyvgart + Vyvgart Hytrulo

efgartigimod alfa-fcab (FcRn inhibitor)

AChR+ gMG (FcRn antagonist; IV J9332 + SC Hytrulo J9334; argenx; 10 mg/kg q1w × 4 per cycle; AChR+ ONLY — MuSK+ → Rystiggo)

rozanolixizumab-noli

Generalized myasthenia gravis (AChR+ AND MuSK+; FcRn inhibitor 7 mg/kg SC weekly × 6 per cycle; J9333 = 1 mg/unit; covers MuSK+ unlike Vyvgart)

tremelimumab-actl

HCC (HIMALAYA STRIDE single 300 mg priming + Imfinzi) + NSCLC (POSEIDON 75 mg q3w × 5 + chemo + Imfinzi) — CTLA-4 inhibitor, J9347 = 1 mg/unit

mosunetuzumab-axgb

R/R follicular lymphoma (CD20×CD3 IV bispecific, fixed-duration)

ado-trastuzumab emtansine (T-DM1)

HER2+ mBC + early-stage residual disease post-neoadjuvant (KATHERINE); 3.6 mg/kg q3w; ADC with DM1 payload; HER2-low routes to Enhertu

Herceptin / biosimilars

trastuzumab + Ontruzant, Herzuma, Ogivri, Trazimera, Kanjinti, Hercessi

J9355 Q5112 Q5113 Q5114 Q5116 Q5117 Q5144

HER2+ breast cancer, HER2+ gastric

fam-trastuzumab deruxtecan-nxki

HER2+/low/ultralow breast, HER2+ gastric, HER2+ NSCLC, tumor-agnostic

loncastuximab tesirine-lpyl

R/R DLBCL after 2+ prior therapies (anti-CD19 ADC with PBD payload; 150 mcg/kg → 75 mcg/kg q3w; J9359 = 0.075 mg/unit; 3-day dex premed mandatory)

teclistamab-cqyv

R/R multiple myeloma (BCMA×CD3 SC bispecific, REMS)

teplizumab-mzwv

Delay onset of stage 3 T1D (14-day IV course, anti-CD3)

zenocutuzumab-zbco

NRG1+ NSCLC + pancreatic (HER2/HER3 bispecific, 750 mg flat q2w; NRG1 NGS gate)

fulvestrant (originator + generics)

HR+/HER2- mBC (CDK4/6 combo SOC; bilateral IM)

IDA (IV, 510 mg ×2; non-ESRD vs ESRD codes; Boxed)

axicabtagene ciloleucel (anti-CD19 CAR-T)

DLBCL + FL + 2L LBCL (anti-CD19 CAR-T, Kite/Gilead; CD28 costim — higher CRS; ZUMA-7 brought CAR-T to 2L; Kite Konnect hub; ~$532K/dose)

tisagenlecleucel (anti-CD19 CAR-T)

Peds ALL + adult DLBCL/FL (anti-CD19 CAR-T, Novartis; 4-1BB costim; KymriahCares hub; MS-DRG 018; ~$614K/dose; multi-stage encounter)

Doxil / Lipodox

doxorubicin HCl liposomal (pegylated)

Ovarian (post-platinum), Kaposi, MM (combo with bortezomib)

brexucabtagene autoleucel (anti-CD19 CAR-T)

R/R MCL post-BTKi + adult R/R ALL (anti-CD19 CAR-T, Kite; T-cell enrichment manufacturing for peripheral disease; ZUMA-2/3; ~$489K/dose)

lisocabtagene maraleucel (anti-CD19 CAR-T)

LBCL + CLL/SLL + FL + MCL (anti-CD19 CAR-T, BMS; 4-1BB costim, 1:1 CD8:CD4 ratio — lowest CRS; first CAR-T for CLL via TRANSCEND CLL 004; ~$562K/dose)

idecabtagene vicleucel (anti-BCMA CAR-T)

R/R multiple myeloma (anti-BCMA CAR-T, BMS/2seventy; FIRST BCMA CAR-T; 4-1BB costim; KarMMa-3 to 2L April 2024; ~$560K/dose)

ciltacabtagene autoleucel (anti-BCMA CAR-T)

R/R multiple myeloma (anti-BCMA CAR-T, J&J/Legend; dual BCMA-binding-domain construct; parkinsonism/MNT delayed neurotox; CARTITUDE-4 to 2L April 2024; ~$623K/dose)

epoetin alfa-epbx (biosimilar)

Biosimilar ESA (Epogen/Procrit reference; non-ESRD vs ESRD)

ranibizumab-eqrn (Lucentis biosimilar)

wAMD + DME + RVO + mCNV (interchangeable Lucentis biosimilar; Q5128 = 0.1 mg/unit; CPT 67028 intravitreal; NO pediatric ROP — use J2778 Lucentis)

natalizumab-sztn (biosimilar)

RRMS, Crohn's disease

lutetium Lu 177 dotatate

GEP-NETs (PRRT radioligand, Novartis; CPT 79101 NOT 96365; Ga-68/Cu-64 dotatate PET gate; HOPD-only NRC; ~$56K/dose × 4)

lutetium Lu 177 vipivotide tetraxetan

PSMA+ mCRPC (PSMA radioligand, Novartis; CPT 79101; Pylarify/Locametz PSMA-PET gate; March 2025 pre-taxane expansion; ~$42K/dose × 6)

What makes these references different

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Reviewed by the CareCost editorial team Each page is reviewed and signed off by the CareCost editorial team. Disagreement between manufacturer and payer guidance is surfaced — not hidden.

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Per-section freshness dates ASP data, payer policies, code rules, and FDA labels are tracked and stamped per section. When a source goes stale, you'll see it.

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