This information is intended for U.S. healthcare professionals and/or
healthcare professionals involved in healthcare reimbursement.
This site is intended for U.S. residents 18 years of age or older.
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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
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.
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
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.
Reimbursement and Coding Guide
for POMALYST
Filter results by:
National Drug Codes (NDC)1
Issued by the FDA
| 59572-0501-21 Copy | 1 mg capsules, bottles of 21 |
| 59572-0501-00 Copy | 1 mg capsules, bottles of 100 |
| 59572-0502-21 Copy | 2 mg capsules, bottles of 21 |
| 59572-0502-00 Copy | 2 mg capsules, bottles of 100 |
| 59572-0503-21 Copy | 3 mg capsules, bottles of 21 |
| 59572-0503-00 Copy | 3 mg capsules, bottles of 100 |
| 59572-0504-21 Copy | 4 mg capsules, bottles of 21 |
| 59572-0504-00 Copy | 4 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 Copy | Multiple myeloma and malignant plasma cell neoplasms |
| C90.0 Copy | Multiple myeloma |
| C90.00 Copy | Multiple myeloma not having achieved remission |
| C90.01 Copy | Multiple myeloma in remission |
| C90.02 Copy | Multiple myeloma in relapse |
Kaposi’s Sarcoma (KS) ICD-10 Codes
| C46 Copy | Kaposi’s sarcoma |
| C46.0 Copy | Kaposi’s sarcoma of skin |
| C46.1 Copy | Kaposi's sarcoma of soft tissue | C46.2 Copy | Kaposi's sarcoma of palate |
| C46.3 Copy | Kaposi's sarcoma of lymph nodes |
| C46.4 Copy | Kaposi's sarcoma of gastrointestinal sites |
| C46.5 Copy | Kaposi's sarcoma of lung |
| C46.50 Copy | Kaposi's sarcoma of unspecified lung |
| C46.51 Copy | Kaposi’s sarcoma of right lung |
| C46.52 Copy | Kaposi’s sarcoma of left lung |
| C46.7 Copy | Kaposi’s sarcoma of other sites |
| C46.9 Copy | Kaposi’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.
References:
- POMALYST [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
- 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 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:
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
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.
