Codes and coverage

Codes and coverage

Supporting patient access

BMS Access Support® may help support patient access by conducting benefits reviews and offering prior authorization and appeals process assistance for enrolled patients. Additionally, the information below provides product-specific billing and diagnosis codes, reimbursement and coding guides, distribution information, and additional coverage support offerings. To view available coding and coverage information, please select your patient’s prescribed medication.

Additional eligibility criteria and terms may apply. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

Read more about our coverage support offerings
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Benefits Reviews

  • Once a patient is enrolled in BMS Access Support, we can review their insurance coverage and provide a summary of benefits within approximately 24 hours*
  • A benefits review may help determine whether or not a medication is covered, if a PA is required, and estimated patient out-of-pocket costs

*BMS Access Support Data - Benefits review. Accessed August 2022.

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Prior Authorization (PA) and Appeals Assistance

  • Use the BMS Access Map to identify plan-specific PA requirements
  • View our forms and resources page for helpful support tools, including appeals letter templates and medical necessity letters

Annual Reverification

  • Reverification of benefits is available upon request to confirm a patient’s benefits for the new year
  • Connect with your local Access and Reimbursement Manager for more information
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The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

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Reimbursement and Coding Guide
for IDHIFA

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National Drug Codes (NDC)1

Issued by the FDA

Note: Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.

59572-0705-30 Copy 50-mg tablets; one bottle containing 30 tablets
59572-0710-30 Copy 100-mg tablets; one bottle containing 30 tablets

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)2

C92 Copy Myeloid Leukemia
C92.0 Copy Acute myeloblastic leukemia
C92.00 Copy Acute myeloblastic leukemia, not having achieved remission
C92.01 Copy Acute myeloblastic leukemia, in remission
C92.02 Copy Acute myeloblastic leukemia, in relapse

Coding for IDHIFA is dependent on the insurer and the care setting in which the drug will be administered. Healthcare providers need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.

Please see U.S. Full Prescribing Information for IDHIFA, including Boxed WARNING.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient’s medical record, the coding requirements of each health insurer, and best coding practices. Coding guidance provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

References:

  1. IDHIFA (enasidenib) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. https://www.cms.gov/medicare/coding-billing/icd-10-codes/2023-icd-10-cm. Accessed August 3, 2023.

IDHIFA may be purchased through the distributors listed below.

Physician Offices

Authorized Distributor Phone Orders Fax Orders and Website
Cardinal Health Specialty Pharmaceutical Distribution 1-877-453-3972 https://specialtyonline.cardinalhealth.com
CuraScript Specialty Distribution 1-877-599-7748 https://www.curascriptsd.com
McKesson Specialty Health 1-800-482-6700 https://mscs.mckesson.com
Morris & Dickson Specialty 1-800-710-6100 Fax: 1-318-524-3096
https://www.mdspecialtydist.com
Oncology Supply 1-800-633-7555 https://www.oncologysupply.com

For offices that prefer to use the services of a specialty pharmacy, specialty pharmacies can obtain IDHIFA from the distributors listed above.

Hospitals and Infusion Centers

Authorized Distributor Phone Orders Fax Orders and Website
ASD Healthcare 1-800-746-6273 Fax: 1-800-547-9413
https://www.asdhealthcare.com
Cardinal Health Specialty Pharmaceutical Distribution 1-866-677-4844 Fax: 1-614-553-6301
https://orderexpress.cardinalhealth.com
McKesson Plasma and Biologics 1-877-625-2566 Fax: 1-888-752-7626
https://connect.mckesson.com
Morris & Dickson Specialty 1-800-710-6100 Fax: 1-318-524-3096
https://www.mdspecialtydist.com

Puerto Rico Hospitals and Clinics

Authorized Distributor Phone Orders Fax Orders and Website
Amerisource
Bergen Puerto Rico
1-844-222-2273 https://abcorder.amerisourcebergen.com
Cardinal Puerto Rico (Borschow) 1-787-625-4200 https://www.cardinalhealth.pr
Cesar Castillo, Inc. 1-787-641-5242 (Hospitals)
1-787-641-5082 (Specialty Pharmacy)
Fax: 1-787-999-1614 https://www.facilfarmaciacci.com

Above information is accurate as of 12/23.

The IDHIFA distribution program includes extended payment terms to Bristol Myers Squibb authorized IDHIFA distributors. Healthcare providers and institutions should contact their IDHIFA distributor to understand specific payment terms that may be available to them from their distributor.

Please see U.S. Full Prescribing Information for IDHIFA, including Boxed WARNING.

FDA Approval Letter as Posted by the FDA:

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For the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with an isocitrate dehydrogenase-2 (IDH2) mutation as detected by an FDA-approved test

View Letter

Please see U.S. Full Prescribing Information for IDHIFA, including Boxed WARNING.