Fosaprepitant Dimeglumine and Aprepitant: Part B and Part D Coverage

EMEND for Injection (Day 1) and oral EMEND (Day 2 + Day 3)

Part B coverage

EMEND for Injection is eligible when all 3 criteria below are met:

• Considered to be of the type of injectable drug that is not usually self-administered
• Considered to be incident to a physician’s services
• Reasonable and necessary for diagnosis or treatment of the illness or injury for which it is administered

Check with your local carrier or A/B MAC for applicable policies and procedures.

Part D coverage

The bifold pack of EMEND is eligible for Medicare Part D coverage when used after EMEND for Injection.

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.

Prescription stamp

For a supply of prescription stamps and stickers, contact Merck or ask your Merck sales representative.

See more information about sample prescription documentation for claims processing.

All-oral regimen of EMEND

Part B coverage

The all-oral regimen of EMEND is covered under Medicare Part B when both of the following criteria are met:

1. EMEND was prescribed in combination with an oral 5-HT₃ receptor antagonist and oral dexamethasone.
2. One or more of the following anticancer chemotherapeutic agents was administered:

Part D coverage

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.

Prescription stamp and sticker

To facilitate Medicare claims processing when using an all-oral regimen of EMEND, you can use the prescription stamp and the sticker to provide relevant information when prescribing the bifold pack of oral EMEND. This may assist your Medicare patients at the pharmacy.

For a supply of prescription stamps, contact Merck or ask your Merck sales representative.

See more information about sample prescription documentation for claims processing.