New US billing code speeds access to myeloma treatment Blenrep
New reimbursement pathway removes administrative barrier for patients
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U.S. authorities have granted a permanent billing code for Blenrep (belantamab mafodotin), an approved treatment for certain adults with hard-to-treat multiple myeloma., a move the drug’s maker, GSK, said will facilitate access and support timely treatment.
The Centers for Medicare and Medicaid Services (CMS), a government agency responsible for overseeing Medicare and Medicaid — publicly funded programs that provide health insurance to elderly and disadvantaged people in the U.S. — assigns a code to each treatment so it can be easily identified and processed for coverage.
“We now have a clear, consistent reimbursement pathway – removing administrative barriers and enabling the right patients to access treatment faster,” Patrick Connor, head of U.S. oncology at GSK, said in a company press release.
Blenrep is approved in the U.S. to treat certain people with relapsed or refractory myeloma, meaning the cancer has failed to respond or come back following initial treatments. The therapy is specifically indicated as part of a combination regimen with Velcade (bortezomib) and dexamethasone for adults with relapsed or refractory myeloma who have received at least two previous lines of therapy, including a proteasome inhibitor and an immunomodulatory agent.
“Patients with multiple myeloma often endure an ongoing cycle of relapse and remission,” Connor said. “Having effective therapies that help them stay in remission and live longer is critical – and so is timely access without delays due to billing and reimbursement complexity.”
Most patients receive drug in centers, not hospitals
Blenrep contains a cell-killing chemotherapy drug attached to an antibody that targets a protein found on myeloma cells. The therapy is designed for the antibody to bring the toxic drug directly to cancer cells, killing them.
GSK said streamlining reimbursement for Blenrep is especially critical because most myeloma patients are treated in community centers, rather than specialty hospitals.
“The majority of patients with multiple myeloma receive care close to home – in community settings – where clarity and predictability in reimbursement are essential to delivering timely care,” said Joseph Mikhael, MD, director of myeloma research at the Honorhealth Research Institute and medical advisor for the International Myeloma Foundation. “A permanent … code improves reimbursement processes and reduces administrative burden, so providers can stay focused on patients and patients can stay focused on their treatment,”
GSK offers a support program, Together with GSK, which is available to all patients prescribed Blenrep. The program includes educational and support resources as well as assistance in navigating insurance coverage.
CMS assigned Blenrep the code J9053 under the Healthcare Common Procedure Coding System. Codes starting with J are assigned to non-oral medications like Blenrep, which is given by infusion into the bloodstream.
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