Benefits Reviews
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.
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.
National Drug Codes (NDC)1
Issued by the FDA
| 59572-0402-28 | 2.5 mg bottles of 28 capsules |
| 59572-0402-00 | 2.5 mg bottles of 100 capsules |
| 59572-0405-28 | 5 mg bottles of 28 capsules |
| 59572-0405-00 | 5 mg bottles of 100 capsules |
| 59572-0410-28 | 10 mg bottles of 28 capsules |
| 59572-0410-00 | 10 mg bottles of 100 capsules |
| 59572-0415-21 | 15 mg bottles of 21 capsules |
| 59572-0415-00 | 15 mg bottles of 100 capsules |
| 59572-0420-21 | 20 mg bottles of 21 capsules |
| 59572-0420-00 | 20 mg bottles of 100 capsules |
| 59572-0425-21 | 25 mg bottles of 21 capsules |
| 59572-0425-00 | 25 mg bottles of 100 capsules |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)2
Coding for REVLIMID 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 REVLIMID, 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:
- REVLIMID [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/ICD10/2023-ICD-10-CM. Accessed July 5, 2023.
Prescribers and pharmacies must be certified with the Lenalidomide REMS program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to receive REVLIMID. 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 Orders |
| Absolute Pharmacy | Phone: 1-787-892-8700
Fax: 1-787-496-1010
|
| AcariaHealth Pharmacy | Phone: 1-866-458-9246
Fax: 1-866-458-9245
|
| Accredo Specialty Pharmacy | Phone: 1-877-732-3431
Fax: 1-800-590-1021
|
| ACS Advanced Care Scripts | Phone: 1-877-985-6337
Fax: 1-866-679-7131
|
| AllianceRx Walgreens Prime | Phone: 1-888-347-3416
Fax: 1-877-231-8302
|
| Amber Specialty Pharmacy | Phone: 1-888-370-1724
Fax: 1-877-645-7514
|
| Axium Healthcare Puerto Rico | Phone: 1-787-780-7200
Fax: 1-800-546-2163
|
| Biologics by McKesson | Phone: 1-800-850-4306
Fax: 1-800-823-4506
|
| Biomatrix | Phone: 1-888-662-6779
Fax: 1-877-800-4790
|
| BioPlus Specialty Pharmacy | Phone: 1-888-292-0744
Fax: 1-800-269-5493
|
| CareMed Specialty Pharmacy | Phone: 1-877-227-3405
Fax: 1-877-542-2731
|
| CVS Specialty | Phone: 1-800-237-2767
Fax: 1-800-323-2445
|
| Farmacia San Rafael | Phone: 1-787-724-3333
Fax: 1-787-721-4165
|
| Humana Specialty Pharmacy | Phone: 1-800-486-2668
Fax: 1-877-405-7940
|
| Kroger Specialty Pharmacy | Phone: 1-888-327-2962
Fax: 1-888-315-3270
|
| Magellan Rx Pharmacy (ICORE) | Phone: 1-866-554-2673
Fax: 1-866-364-2673
|
| Onco360 | Phone: 1-877-662-6633
Fax: 1-877-662-6355
|
| Optum Specialty Pharmacy | Phone: 1-877-445-6874
Fax: 1-866-306-5231
|
| RxCrossroads by McKesson (VA Dispensing) | Phone: 1-855-637-9433
Fax: 1-855-637-9446
|
| Special Care Pharmacy Services | Phone: 1-787-783-8579
Fax: 1-787-783-2951
|
| Upstate Pharmacy | Phone: 1-800-314-4655
Fax: 1-800-314-7756
|
| US Bioservices | Phone: 1-877-757-0667
Fax: 1-888-899-0067
|
Above information is accurate as of 01/26.
The REVLIMID distribution program includes extended payment terms to Bristol Myers Squibb authorized REVLIMID distributors. Healthcare providers and institutions should contact their REVLIMID distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for REVLIMID, including Boxed WARNINGS.
FDA Approval Letters as Posted by the FDA:
See Payer Policy Details
Learn about payer information by state for applicable treatments.
