Jemperli (dostarlimab-gxly) — HCPCS J9272

CareCost Estimate · Billing Cheat Sheet

GlaxoSmithKline (GSK) 500 mg / 10 mL single-dose vial IV infusion 30 min · anti-PD-1 Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J9272

10 mg = 1 unit (NOT 1 mg)

50 units

500 mg q3wk x 4 cycles

Maintenance

100 units

1,000 mg q6wk (cycle 5+)

Admin / Mod

96413 · JZ

Chemo IV · no waste

Medicare ASP+6%

$247.083

/unit · $12,354.15/500 mg

RUBY 1L endometrial: Jemperli 500 mg + carboplatin AUC 5 + paclitaxel 175 mg/m² q3wk x 6 cycles, then Jemperli 1,000 mg q6wk maintenance until progression. NCCN-preferred 1L for advanced/recurrent endometrial cancer (FDA dMMR/MSI-H Jul 2023; all-MMR Aug 2024).

Codes & NDC

HCPCS	`J9272` — "Inj, dostarlimab-gxly, 10 mg" (10 mg = 1 unit; unusual for ICI class)
NDC	`0173-0898-01` (10) / `00173-0898-01` (11) — N4 qualifier, ML, 10 mL (500 mg) or 20 mL (1,000 mg)
Vial	500 mg / 10 mL (50 mg/mL) single-dose
Class	anti-PD-1 (same target as Keytruda J9271, Opdivo J9299, Libtayo J9119)
Benefit	Medical (provider buy-and-bill); not specialty pharmacy

Dosing transition

Phase	Dose	Interval	Units	Vials
Loading (cycles 1-4 mono / 1-6 RUBY)	500 mg	q3wk	50	1 x 500 mg
Maintenance (cycle 5+ mono / 7+ RUBY)	1,000 mg	q6wk	100	2 x 500 mg

Hard transition. At cycle 5 (mono) or cycle 7 (RUBY), BOTH dose AND interval change. Verify on regimen sheet — #1 transition error.

MMR / MSI-H biomarker

Test	CPT	Notes
MMR IHC (4-protein)	`88342` (initial) + `88341` x 3	MLH1, MSH2, MSH6, PMS2; loss of any = dMMR
MSI by PCR	`81525` / `81479`	Bethesda 5-marker panel
MSI by NGS	`0244U` (FoundationOne CDx)	From CGP panel

Required: 1L endometrial dMMR/MSI-H + tumor-agnostic dMMR
Not FDA-required (but payer may ask): 1L endometrial all-MMR (Aug 2024)
Universal MMR screening at endometrial biopsy is ASCO/SGO standard

Administration & modifiers

Code	When
`96413`	Chemo IV up to 1 hr (primary, 30-min infusion)
`96415`	Each addl hr — for RUBY combo days w/ paclitaxel
`96417`	Sequential infusion — for carbo on combo days
`96365`	NOT appropriate — ICI billed as chemo admin
JZ on virtually every claim (whole-vial fills). JW almost never applies (fixed dose, no waste).

FDA-approved indications

Indication	ICD-10
1L endometrial (RUBY combo) — advanced/recurrent, all MMR (Aug 2024); + carbo/paclitaxel	`C54.x` / `C55`
Recurrent/advanced endometrial post-platinum (any MMR)	`C54.x` + `Z85.42`
Recurrent/advanced dMMR endometrial post-platinum	`C54.x` + dMMR docs
dMMR solid tumors (tumor-agnostic, accelerated)	Any C-code + dMMR/MSI-H docs

Endometrial is the volume-driving indication. RUBY trial established preferred 1L per NCCN.

Payer requirements (May 2026)

Payer	PA	Enforcement
UnitedHealthcare	Yes	dMMR/MSI-H docs + RUBY-aligned regimen for 1L endometrial
Aetna (CPB 0892)	Yes	Same; ICI site-of-care steering after 3 mo
BCBS plans	Yes	Aligned w/ NCCN + FDA label biomarkers
Medicare (MAC LCDs)	No (Part B)	Doc'd FDA-label indication + ICD-10 + biomarker

Step therapy: generally not required for 1L endometrial or tumor-agnostic dMMR. Some payers steer to Keytruda + chemo (KEYNOTE-868) as comparable 1L endometrial.

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6%	$247.083 per 10 mg unit (~$24.71/mg)
500 mg loading dose	$12,354.15 (50 units)
1,000 mg maintenance dose	$24,708.30 (100 units)
Year-1 total (mono, 4 + ~7 doses)	~$272,000
Steady-state (yr 2+, ~8-9 doses/yr)	~$197,666/yr

Site of care

Setting	POS	Notes
Physician / gyn-onc office	11	Preferred for q6wk maintenance
Ambulatory infusion suite	49	Preferred
Hospital outpatient	22 / 19	OK during combo phase; disfavored after 3 mo on mono

Patient assistance — GSK For You / Jemperli Together

Phone: 1-844-468-2225 (1-844-GSK-2BCK)
Jemperli Together: $0 first dose for commercially-insured
GSK Bridges to Access: free drug for uninsured/underinsured
Foundations (Medicare): PAN, HealthWell, CancerCare
Web: gskforyou.com / jemperli.com

W&P (boxed-analog) — severe irAEs: Pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, dermatologic (incl. SJS/TEN), infusion reactions, embryo-fetal toxicity. Same management as Keytruda/Opdivo — high-dose steroids + organ-specific consult; hold/discontinue per grade.

Sources: FDA label Aug 2024 (BLA 761174), CMS ASP Q2 2026, GSK 2025 coding & coverage, RUBY (Mirza NEJM 2023), NCCN Endometrial Cancer Guidelines, UHC/Aetna ICI policies. carecostestimate.com/drugs/jemperli