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August 22, 2012

New Drug Approvals: Carfilzomib (Kyprolis), Ziv-Aflibercept (Zaltrap)

Coverage requirements for Carfilzomib and Ziv-aflibercept are listed below. Please follow the Not Otherwise Classified filing instructions when submitting claims for new drugs/biologicals.

Carfilzomib (Kyprolis) J9999

Covered for the treatment of patients with multiple myeloma 203.00 or 203.02. Documentation must be in the patients file that the patient has received at least two prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy. Reimbursement will be based on 60mg/SDV as being 1 unit.

Ziv-aflibercept (Zaltrap) J9999

Covered for patients with metastatic colorectal cancer (mCRC) 154.0. Zaltrap is used in combination with 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI). The patient's medical record must document MCRC is resistant to or has progressed following an oxaliplatin-containing regimen. Reimbursement will be based on 100mg/4ml as being 1 unit.

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