Cahaba Updates Self-Administered Drug (SAD) List

on Monday, 28 December 2009. All News Items

Cahaba GBA recently published a revision to their Self-Administered Drug List.  The drug Certolizumab pegol (Cimzia®) is being added to the SAD list.  The unclassified HCPCS code J3590 was originally assigned to use for this drug; HCPCS code C9249 (Injection, certolizumab pegol, 1 mg) was effective April 1, 2009 and HCPCS code J0718 (Injection, certolizumab pegol, 1 mg) will be effective for dates of service on and after January 1, 2010.

Per the Cahaba announcement, the rationale for adding this drug to the SAD list is apparent on its face.  SC injection administered by patient for a chronic condition.  Since Cimzia® is available in a pre-filled syringe for self-administration, the Lyophilized Powder for Reconstitution is not covered.

The effective date of non-coverage for this update is February 1, 2010.

The ‘Self-Administered Drug (SAD) List’ article can be accessed from the Cahaba GBA website at the Local Coverage Determinations (LCDs) and Articles page (choose the ‘SAD List’ for your state).

The announcement of this SAD revision can be viewed at the Cahaba GBA website: Cahaba GBA SAD Update.

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