Retacrit (epoetin alfa-epbx) — HCPCS Q5106 / Q5105
CareCost Estimate · Billing Cheat Sheet
Pfizer (Hospira)
2,000 / 3,000 / 4,000 / 10,000 / 20,000 / 40,000 IU SDV
SC or IV
Reviewed: May 2, 2026
ASP: Q4 2026
HCPCS (non-ESRD)
Q5106
1,000 IU = 1 unit
HCPCS (ESRD HD)
Q5105
100 IU = 1 unit
Modifier
JZ
JW for waste; SDV always
Admin CPT
96372
SC (or 96365 IV); none ESRD-PPS
Q5106 ASP+6%
$8.171
/1,000 IU · $326.84 / 40k IU
BOXED WARNING (class): Increased risk of death, serious cardiovascular events, thromboembolism, stroke, and tumor progression / recurrence (cancer). Use lowest dose to avoid transfusion. KDIGO target Hgb 10-11 g/dL. ESA APPRISE Oncology REMS required for cancer indication.
Codes — dual unit basis
| Q5106 (non-ESRD) | Q5105 (ESRD HD) |
|---|
| Unit | 1,000 IU | 100 IU |
| Use | NDD-CKD, chemo, surgery, HIV, AKI | ESRD on dialysis only |
| ICD-10 | Per indication (D63.1, D64.81) | N18.6 + Z99.2 + D63.1 |
| Pay | ASP+6% (separately billable) | Bundled in ESRD PPS |
| ASP+6% | $8.171 / 1,000 IU | $0.817 / 100 IU |
| Per IU | $0.00788 | $0.00788 (identical) |
Unit-basis trap: 10,000 IU dose = 10 units Q5106 OR 100 units Q5105. 10x difference, same drug. Wrong code = denial AND wrong unit math.
Vial sizes & NDC (representative)
| Vial | NDC |
|---|
| 2,000 IU | 59676-0302-01 |
| 3,000 IU | 59676-0303-01 |
| 4,000 IU | 59676-0304-01 |
| 10,000 IU | 59676-0310-01 |
| 20,000 IU | 59676-0320-01 |
| 40,000 IU | 59676-0340-01 |
All single-dose vials. JZ for whole-vial; JW for waste portion. Verify package NDC at billing time.
Dosing
- CKD anemia: 50-100 IU/kg 3×/wk SC or IV; titrate Hgb 10-11 g/dL
- Chemo-induced anemia (non-myeloid): 150 IU/kg SC 3×/wk OR 40,000 IU SC weekly
- HIV (zidovudine): 100-300 IU/kg SC or IV 3×/wk
- Surgery: 300 IU/kg/d SC × 15 days OR 600 IU/kg weekly × 4
- Iron-replete required: ferritin >100, TSAT >20%
ESA APPRISE Oncology REMS
- Required for cancer indication only (not CKD)
- Prescriber + institution enrollment
- Patient acknowledgment form signed before each chemo course
- Documents understanding of mortality, CV, thrombosis, tumor-progression risks
- Web: esa-apprise.com
Common error: Acknowledgment signed once per patient lifetime instead of each chemo course. Triggers payer denial + REMS audit.
ICD-10 by indication
| Indication | ICD-10 | HCPCS |
|---|
| NDD-CKD anemia | N18.3-N18.5 + D63.1 | Q5106 |
| ESRD on dialysis | N18.6 + Z99.2 + D63.1 | Q5105 |
| AKI on temp dialysis | N17.x + D63.8 | Q5106 |
| Chemo-induced anemia | D64.81 + cancer C-code | Q5106 |
| HIV (zidovudine) | B20 + D63.8 | Q5106 |
| Perioperative | Anemia + procedure Z code | Q5106 |
| Myeloid (AML/MDS/CML) | NOT FDA-approved for ESAs. Consider Reblozyl (J0896). |
Hgb <10 g/dL at initiation + iron-replete labs (ferritin >100, TSAT >20%) required by most LCDs/payers.
ESA class comparison
| Drug | HCPCS | Class |
|---|
| Retacrit | Q5106 / Q5105 | 1st FDA biosimilar epoetin alfa |
| Epogen / Procrit | J0885 | Reference epoetin alfa |
| Aranesp | J0881 / J0882 | Long-acting darbepoetin |
| Mircera | J0888 | Long-acting epoetin beta |
Biosimilar-preferred wave: UHC, Aetna, BCBS, OptumRx (Nuvaila), CVS Cordavis, ESI Quallent 2024-2026 policies prefer Retacrit over reference J0885.
Payer requirements (May 2026)
| Payer | PA | Preference |
|---|
| UnitedHealthcare | Yes | Retacrit preferred over J0885 |
| Aetna | Yes | Biosimilar preferred |
| OptumRx / Nuvaila | Yes | Private-label biosimilar |
| CVS Cordavis / ESI Quallent | Plan-dep. | Private-label biosimilar |
| Medicare FFS | No (LCD) | No preference (ASP+6%) |
Step therapy: Most plans require Retacrit trial before approving reference J0885.
Medicare reimbursement (Q4 2026)
| Field | Value |
|---|
| Q5106 ASP+6% | $8.171 / 1,000 IU |
| Q5105 ASP+6% | $0.817 / 100 IU (bundled ESRD PPS) |
| 40,000 IU dose (Q5106) | $326.84 (40 × ASP+6%) |
| 12-week chemo course | ~$3,784 drug + admin |
| Per-IU cost | $0.00788 (identical Q5106 / Q5105) |
Patient assistance — Pfizer Encompass
- Phone: 1-844-989-7873 (Pfizer Encompass)
- Retacrit Co-pay Program: commercial copay support
- Pfizer Patient Assistance Foundation: free product for uninsured/underinsured
- PAN, HealthWell, CancerCare: Medicare patients (chemo)
- Web: pfizerencompass.com