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
Note: Payers require the submission of the 11-digit NDC on healthcare claim forms. Please use the 11-digit codes shown here.
| 59572-0205-17 | 50 mg/individual blister packs of 1 capsule |
| 59572-0205-14 | 50 mg/individual blister packs of 28 capsules |
| 59572-0210-15 | 100 mg/individual blister packs of 28 capsules |
| 59572-0215-13 | 150 mg/individual blister packs of 28 capsules |
| 59572-0220-16 | 200 mg/individual blister packs of 28 capsules |
International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)
| Multiple Myeloma ICD-10 Codes2 | |
| C90 | Multiple myeloma and malignant plasma cell neoplasms |
| C90.0 | Multiple myeloma |
| Leprosy (Hansen’s disease) ICD-10 Codes2 | |
| A30 | Leprosy (Hansen’s disease) |
| A30.0 | Indeterminate leprosy |
| A30.1 | Tuberculoid leprosy |
| A30.2 | Borderline tuberculoid leprosy |
| A30.3 | Borderline leprosy |
| A30.4 | Borderline lepromatous leprosy |
| A30.5 | Lepromatous leprosy |
| A30.8 | Other forms of leprosy |
| A30.9 | Leprosy, unspecified |
Coding for THALOMID 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 THALOMID, 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:
- THALOMID (thalidomide) [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 August 3, 2023.
Prescribers and pharmacies must be certified with the THALOMID REMS® program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to received THALOMID. 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 THALOMID distribution program includes extended payment terms to Bristol Myers Squibb authorized THALOMID distributors. Healthcare providers and institutions should contact their THALOMID distributor to understand specific payment terms that may be available to them from their distributor.
Please see U.S. Full Prescribing Information for THALOMID, including Boxed WARNINGS.
FDA Approval Letters as Posted by the FDA:
For the treatment of patients with newly diagnosed multiple myeloma in combination with dexamethasone
For the acute treatment of cutaneous manifestations of moderate to severe ENL (erythema nodosum leprosum)
Note: THALOMID is not indicated as monotherapy for such ENL treatment in the presence of moderate to severe neuritis.
For maintenance therapy for the prevention and suppression of the cutaneous manifestations of ENL recurrence
Please see U.S. Full Prescribing Information for THALOMID, including Boxed WARNINGS.
See Payer Policy Details
Learn about payer information by state for applicable treatments.
