Important cancer drug submission requirements

Review these important submission instructions for select cancer drugs.

Lupron or Eligard (leuprolide acetate)

In the Route menu, select Intramuscular for Lupron J9217 or J1950, or Subcutaneous for Eligard J9217.

Zometa (zoledronic acid)

For Zometa (zoledronic acid), enter only J3489 or zoledronic acid. You cannot enter Zometa.

Faslodex (fulvestrant)

Enter Faslodex for J9395 or fulvestrant for J9393, J9394, or J9395.

Zytiga or Yonsa (abiraterone)

Enter abiraterone acetate for Zytiga or abiraterone acetate micronized for Yonsa. On the subsequent screens, choose the correct Zytiga or Yonsa regimen.

Phesgo (trastuzumab and hyaluronidase-zzxf)

Phesgo is a combination subcutaneous injection treatment for breast cancer. When the physician prescribes Phesgo, enter the following FDA-approved dosing:

Loading dose
Enter 1800mg (1200mg pertuzumab, 600mg trastuzumab, and 30,000 units hyaluronidase). The final treatment plan displays 180 billable units per dose.
Maintenance dose
Enter 1200mg (600mg pertuzumab and 600mg trastuzumab). The final treatment plan displays 120 billable units per dose.

Akynzeo (fosnetupitant-palonosetron)

Akynzeo is a combination drug (fosnetupitant 235mg and palonosetron 0.25mg).

  • For Akynzeo (fosnetupitant-palonosetron) IJ, enter J1454. For Akynzeo (netupitant-palonosetron) capsules, enter J8655.
  • Enter the dose as 0.25mg for IJ or capsules.

Opdualag (nivolumab and relatlimab-rmbw, J9298)

For patients 40kg or greater, enter a dose as 40 units (2-20ml vials). For patients less than 40kg, enter a dose as 20 units (1-20ml vial). The final treatment plan displays 160 billable units per dose for patients 40kg or greater, and 80 billable units per dose for patients less than 40kg.

Inqovi (decitabine and cedazuridine, J8999)

Enter dose as 1 unit, days 1–5, every 28 days. Your authorization will identify 1 billing unit per dose.

Radioactive iodine (RAI, also called I-131) for thyroid carcinoma

The Eviti medical office reviews RAI for thyroid carcinoma for ablation treatment only, not for diagnostic procedures.

You must register the provider in the Eviti system as a medical oncologist even if they're a radiation oncologist. Submit RAI as a chemotherapy drug as follows:

  • Thyrogen (J3240)
  • I-131 is not in the Eviti system. Instead, enter J0000 or Novel Agent, and submit provider orders identifying whether A9517 (capsules) or A9530 (oral solution).

If you need help, call NantHealth Support at 1-888-482-8057.