EMEND—Approved by Medicare for Part B
On this site, you will find Medicare resources including outpatient and office-based billing codes for EMEND.
The table below explains Medicare Part B and Part D coverage for EMEND.
Medicare Part B
Medicare Part D
EMEND is prescribed with an oral
Covers oral antiemetics that are
- Used as a full therapeutic replacement for an I.V. antiemetic that otherwise would have been administered at the time of chemotherapy treatment.
- Administered within 2 hours before and 48 hours after administration of the chemotherapy drug.
- Prescribed for a patient receiving 1 or more of the following anticancer chemotherapeutic agents: carmustine, cisplatin, cyclophosphamide, dacarbazine, mechlorethamine, streptozocin, doxorubicin, epirubicin, lomustine.
Covers medically accepted indications of EMEND that are not covered by Part B.
Claims should be billed to the appropriate DMERC or DME MAC.*
Claims should be billed to the appropriate Medicare prescription drug plan (PDP).
*
DME MACs (Durable Medical Equipment Medicare Administrative Contractors) have replaced DMERCs (Durable Medical Equipment Regional Carriers). For additional information, please consult the Centers for Medicare & Medicaid Services (CMS) Web site.
Writing a Prescription for EMEND for Appropriate Patients
To ensure that the dispensing pharmacy has the appropriate documentation to determine if the use of EMEND is to be billed to either Medicare Part B or Part D, please use the enclosed prescription stickers or document the antiemetic and chemotherapy regimens on the prescription. If using the enclosed stickers, please be sure to check the box on the sticker that applies to your patient’s prescription.
An example is provided below:
Medicare Part B
Aprepitant was prescribed
-
In combination with an oral 5-HT3 receptor antagonist and oral dexamethasone
AND - For a patient receiving 1 or more of the following anticancer chemotherapeutic agents: carmustine, cisplatin, cyclophosphamide, dacarbazine, mechlorethamine, streptozocin, doxorubicin, epirubicin, lomustine
Medicare Part D
Aprepitant was not prescribed for a medically accepted indication that is not in accordance with the Medicare Part B coverage guidelines found in the National Coverage Decision for Aprepitant.
If the patient's claim is reimbursable under Medicare Part B, please instruct him or her to find a pharmacy or supplier that is eligible to bill drugs to the Part B DME MAC.
- By visiting the CMS (Centers for Medicare and Medicaid Services) Web site
- By calling the ACT program, the reimbursement and patient support program sponsored by Merck & Co., Inc., at 866-EMEND-Rx (866-363-6379)
Selected Important Risk Information
The most frequent adverse events reported in clinical trials of EMEND for highly emetogenic chemotherapy were asthenia/fatigue (17.8%), nausea (12.7%), hiccups (10.8%), constipation (10.3%), diarrhea (10.3%), and anorexia (10.1%).
The most frequent adverse events reported in clinical trials of EMEND for moderately emetogenic chemotherapy were alopecia (24.0%), fatigue (21.9%), headache (16.4%), constipation (12.3%), neutropenia (8.9%), dyspepsia (8.4%), stomatitis (5.3%), hot flush (3.0%), and pharyngolaryngeal pain (3.0%).
Before prescribing EMEND and EMEND for Injection, please read the Prescribing Information. The Patient Information also is available.
For information about Merck products or services, please call 866-448-7590. The Merck National Service Center will be pleased to assist you Monday through Friday from 8 AM to 7 PM ET.
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