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

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National Drug Codes (NDC)1

Issued by the FDA

59572-0501-21 Copy1 mg capsules, bottles of 21
59572-0501-00 Copy1 mg capsules, bottles of 100
59572-0502-21 Copy2 mg capsules, bottles of 21
59572-0502-00 Copy2 mg capsules, bottles of 100
59572-0503-21 Copy3 mg capsules, bottles of 21
59572-0503-00 Copy3 mg capsules, bottles of 100
59572-0504-21 Copy4 mg capsules, bottles of 21
59572-0504-00 Copy4 mg capsules, bottles of 100

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

Multiple Myeloma ICD-10 Codes

C90 CopyMultiple myeloma and malignant plasma cell neoplasms
C90.0 CopyMultiple myeloma
C90.00 CopyMultiple myeloma not having achieved remission
C90.01 CopyMultiple myeloma in remission
C90.02 CopyMultiple myeloma in relapse

Kaposi’s Sarcoma (KS) ICD-10 Codes

C46 CopyKaposi’s sarcoma
C46.0 CopyKaposi’s sarcoma of skin
C46.1 CopyKaposi's sarcoma of soft tissue
C46.2 CopyKaposi's sarcoma of palate
C46.3 CopyKaposi's sarcoma of lymph nodes
C46.4 CopyKaposi's sarcoma of gastrointestinal sites
C46.5 CopyKaposi's sarcoma of lung
C46.50 CopyKaposi's sarcoma of unspecified lung
C46.51 CopyKaposi’s sarcoma of right lung
C46.52 CopyKaposi’s sarcoma of left lung
C46.7 CopyKaposi’s sarcoma of other sites
C46.9 CopyKaposi’s sarcoma, unspecified

Coding for POMALYST is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices 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 POMALYST, including Boxed WARNINGS.

*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.


  1. POMALYST [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. Centers for Medicare & Medicaid Services. ICD-10-CM tabular list of diseases and injuries. Accessed July 11, 2023.

Prescribers and pharmacies must be certified with the POMALYST REMS® program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to receive POMALYST. The REMS-Pharmacy Network list includes specialty pharmacies that are contracted to fill prescriptions for restricted distribution programs for Bristol Myers Squibb.

Specialty Pharmacies

Pharmacy Phone Fax
Absolute Pharmacy 1-787-892-8700 1-787-496-1010
AcariaHealth Pharmacy 1-866-458-9246 1-866-458-9245
Accredo Specialty Pharmacy 1-877-732-3431 1-800-590-1021
ACS Advanced Care Scripts 1-877-985-6337 1-866-679-7131
AllianceRx Walgreens Prime 1-888-347-3416 1-877-231-8302
Amber Specialty Pharmacy 1-888-370-1724 1-877-645-7514
Axium Healthcare Puerto Rico 1-787-780-7200 1-800-546-2163
Biologics by McKesson 1-800-850-4306 1-800-823-4506
Biomatrix 1-888-662-6779 1-877-800-4790
BioPlus Specialty Pharmacy 1-888-292-0744 1-800-269-5493
CareMed Specialty Pharmacy 1-877-227-3405 1-877-542-2731
CVS Specialty 1-800-237-2767 1-800-323-2445
Farmacia San Rafael 1-787-724-3333 1-787-721-4165
Humana Specialty Pharmacy 1-800-486-2668 1-877-405-7940
Kroger Specialty Pharmacy 1-888-327-2962 1-888-315-3270
Magellan Rx Pharmacy (ICORE) 1-866-554-2673 1-866-364-2673
Onco360 1-877-662-6633 1-877-662-6355
Optum Specialty Pharmacy 1-877-445-6874 1-866-306-5231
RxCrossroads by McKesson (VA Dispensing) 1-855-637-9433 1-855-637-9446
Special Care Pharmacy Services 1-787-783-8579 1-787-783-2951
Upstate Pharmacy 1-800-314-4655 1-800-314-7756
US Bioservices 1-877-757-0667 1-888-899-0067

Above information is accurate as of 10/23.

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

Please see U.S. Full Prescribing Information for POMALYST, including Boxed WARNINGS.

FDA Approval Letters as Posted by the FDA:

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In combination with dexamethasone, for treatment of patients with multiple myeloma who have received at least two prior therapies including lenalidomide and a proteasome inhibitor and have demonstrated disease progression on or within 60 days of completion of the last therapy

View Letter
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For the treatment of adult patients with AIDS-related Kaposi sarcoma (KS) after failure of highly active antiretroviral therapy (HAART) or in patients with KS who are HIV-negative

View Letter

This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).

Please see U.S. Full Prescribing Information for POMALYST, including Boxed WARNINGS.