Reblozyl (luspatercept-aamt) — HCPCS J0896

CareCost Estimate · Billing Cheat Sheet

Bristol Myers Squibb 25 mg / 75 mg single-dose lyophilized vials Subcutaneous injection q3wk Reviewed: May 2, 2026 ASP: Q2 2026

Unit basis

0.25 mg

= 1 unit (UNUSUAL)

Route

SC q3wk

NOT IV — 96372 admin

Start dose

1 mg/kg

Titrate by indication

Admin CPT

96372

SC therapeutic (or 96401)

Medicare ASP+6%

$42.75

/unit · $171.00/mg

Codes & NDC

HCPCS	`J0896` — "Inj luspatercept-aamt 0.25 mg" (permanent)
NDC 25 mg	`59572-705-01` / `59572070501` (N4 + 11-digit, ML qualifier)
NDC 75 mg	`59572-707-01` / `59572070701`
Vials	25 mg / 75 mg single-dose lyophilized; reconstitute w/ sterile water to 50 mg/mL
Benefit	Medical (provider buy-and-bill); heme/onc clinic dispensing

Dosing by indication

Indication	Start	Max	Approval
Beta-thalassemia (TD)	1 mg/kg q3wk	1.25 mg/kg	Nov 2019
MDS-RS post-ESA	1 mg/kg q3wk	1.75 mg/kg	Apr 2020
MDS 1L (COMMANDS)	1 mg/kg q3wk	1.75 mg/kg	Aug 2023

Hold if Hgb > 11.5 g/dL; resume one level lower
Discontinue if no transfusion reduction after 9 wks (3 doses) at max
Round to nearest whole-vial increment per FDA dose-prep table

Unit math (70 kg patient)

Dose	mg	Units	Vial	Waste (JW)
1.0 mg/kg	70	280	1×75mg	5 mg / 20 u
1.25 mg/kg	87.5	350	75+25	12.5 / 50 u
1.5 mg/kg	105	420	75+25+25	20 / 80 u
1.75 mg/kg	122.5	490	75+25+25	2.5 / 10 u

Always: units = mg ÷ 0.25

Administration & modifiers

Code	When
`96372`	Primary. Therapeutic SC injection
`96401`	Some payers prefer (chemo SC, biologic) — verify
`96365` / `96413`	NOT appropriate — SC drug, not IV
`JZ`	No-waste line (rare; only when dose hits vial increment)
`JW`	Common. Wasted units — weight-based + fixed vials

Both JZ and JW are typical on the same Reblozyl claim: JZ on administered units; JW on discarded units.

ICD-10 — beta-thalassemia

Code	For
`D56.1`	Beta thalassemia (primary — required)
`D56.0/.2/.3/.4/.5/.8/.9`	Other thalassemia variants
`D57.0`–`D57.4`	Sickle cell variants (co-coded)
`Z79.890` + `Z51.81`	Long-term transfusion dependence

FDA label requires "regular RBC transfusions" — submit transfusion log with PA.

ICD-10 — MDS

Code	For
`D46.1`	MDS-RS (orig. 2020 post-ESA indication)
`D46.0`	RA w/o sideroblasts (1L COMMANDS)
`D46.4`	RA unspecified (lower-risk only)
`D46.20/.21/.22/.A`	RAEB (lower-risk subset only)
`D46.9`	MDS unspecified (with IPSS-R doc)
`D47.3`	MDS/MPN-RS-T
`D64.9`	AVOID — will deny

MDS PA needs IPSS-R + ring-sideroblast %. Submit BMA w/ cytogenetics, blast %, SF3B1 if available.

Anemia landscape — not interchangeable

Class	Drug (HCPCS)	Mechanism
EMA	Reblozyl `J0896`	TGF-β trap; late-stage erythroid maturation
ESA	Aranesp `J0881/J0882`; Epogen `J0885`	EPO-receptor; early erythropoiesis stim.
IV iron	Injectafer `J1439`; Monoferric `J1437`	Iron repletion (IDA)

COMMANDS shift (Aug 2023): Reblozyl now 1L for lower-risk MDS regardless of prior ESA. Appeal ESA step therapy with NCCN MDS Guidelines + COMMANDS NEJM 2024.

Payer requirements (May 2026)

Payer	PA	Key criteria
UnitedHealthcare	Yes	Indication-specific; transfusion log; IPSS-R for MDS
Aetna	Yes	BMA results for MDS; Hgb < 11.5 g/dL pre-dose
BCBS plans	Yes	Plan-specific; some still require ESA step
Medicare (orig.)	No	Coverage per FDA label; no NCD

Specialist (heme/onc) prescription typical. SC route → no SOC UM.

Medicare reimbursement (Q2 2026)

Field	Value
ASP+6% per unit	$42.750 (per 0.25 mg)
ASP+6% per mg	$171.000
70 mg dose (1 mg/kg, 70 kg)	$11,970.00 (280 u)
122.5 mg dose (1.75 mg/kg)	$20,947.50 (490 u)
Annual (1 mg/kg, 17 doses)	~$203,490

Patient assistance — BMS Access Support

BMS Access Support: 1-800-861-0048 (BI / PA / appeals)
Reblozyl Patient Support: 1-888-732-7568
Co-pay: $0 first dose commercial
BMS PAF: free drug for uninsured (income-based)
Foundations: PAN, HealthWell, CancerCare (Medicare)
Web: bmsaccesssupport.com

W&P (no Boxed): Thromboembolic events (esp. beta-thalassemia, splenectomized); extramedullary hematopoietic masses (beta-thal, may compress neural structures); HTN; embryo-fetal toxicity. Surveil per indication.

Sources: FDA label (BLA 761136, latest rev), CMS ASP Q2 2026, COMMANDS NEJM 2024, BMS Access Support Mar 2026, NCCN MDS Guidelines, UHC/Aetna luspatercept policies, SEER CanMED J0896. carecostestimate.com/drugs/reblozyl