Antiemetics: National coverage information at emend.com

National Coverage Determination for Aprepitant

Medicare Part B coverage of oral antiemetics

Medicare Part B covers oral antiemetics that are used as a full therapeutic replacement for an intravenous (I.V.) antiemetic regimen that otherwise would have been administered at the time of chemotherapy treatment. Medicare-covered oral antiemetics are administered within 2 hours before and 48 hours after the administration of the chemotherapy drug.

EMEND, in combination with other antiemetic agents, is indicated for prevention of:

• Acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy, including high-dose cisplatin.
• Nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy.

Medicare Part B National Coverage Determination for Aprepitant

Effective April 4, 2005, Medicare Part B covers oral EMEND for chemotherapy-induced nausea and vomiting when used in combination with an oral 5-HT₃ receptor antagonist and oral dexamethasone. Coverage is defined for patients receiving 1 or more of the following anticancer chemotherapeutic agents:

Please refer to the Decision Memo for Aprepitant for Chemotherapy-Induced Emesis (CAG-00248N).

Medicare Part D coverage of oral EMEND

If an all-oral regimen of EMEND does not meet the criteria of the Medicare Part B National Coverage Determination for Aprepitant, coverage may be available under Medicare Part D.

Under Medicare Part D, the availability and amount of reimbursement for individual patients will vary based, for example, on the patient’s benefit design, including the application of any deductible, copay, or coverage limit. You or the patient should contact the Part D plan for the most up-to-date patient-specific coverage and reimbursement information.

Reference: 1. Centers for Medicare & Medicaid Services. Decision memo for aprepitant for chemotherapy-induced emesis (CAG-00248N). cms.hhs.gov/mcd/viewdecisionmemo.asp?id=133. Published April 4, 2005. Updated November 14, 2008. Accessed January 16, 2009.

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