Table 2.
Ten Most Expensive Medicare Part B Payments for Drugs Delivered in Physician Office and at Home
| HCPCS | Name | Dose (mg) | Average Sales Price per Dose | Total Medicare Annual Payment | FDA-Approved Indication |
|---|---|---|---|---|---|
| J2778 | Ranibizumab injection | 0.1 | $396.43 | $1,310,751,832 | Macular degeneration, macular edema, diabetic macular edema |
| J0178 | Aflibercept injection (ophthalmic) | 1 | $980.50 | $1,239,918,536 | Macular degeneration, macular edema, diabetic macular edema, diabetic retinopathy |
| J9310 | Rituximab injection | 100 | $708.68 | $852,588,010 | Non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, Wegener’s granulomatosis and microscopic polyangiitis |
| J1745 | Infliximab injection | 10 | $74.34 | $785,929,255 | Crohn’s disease, pediatric Crohn’s disease, ulcerative colitis, pediatric ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis |
| J2505 | Injection, pegfilgrastim | 6 | $3,387.93 | $641,285,763 | Febrile neutropenia |
| J9035 | Bevacizumab injection | 10 | $66.65 | $593,988,145 | Metastatic colorectal cancer; NSCLC; glioblastoma; renal cell carcinoma; cervical cancer; epithelial ovarian, fallopian tube, or primary peritoneal cancer |
| J0897 | Denosumab injection | 1 | $14.45 | $505,871,083 | Skeletal-related events, giant cell tumor of bone, hypercalcemia of malignancy |
| J9355 | Trastuzumab injection | 10 | $82.49 | $289,275,777 | Breast cancer, gastric or gastroesophageal junction adenocarcinoma |
| J9305 | Pemetrexed injection | 10 | $60.27 | $287,737,319 | NSCLC, mesothelioma |
| J9041 | Bortezomib injection | 0.1 | $46.08 | $283,007,272 | Multiple myeloma, mantle cell lymphoma |
NOTE. Drugs in bold font are used to treat patients with cancer. Pricing data reflect fourth quarter 2014 payment rates, which corresponding to second quarter 2014 manufacturer reports. Final column lists FDA-approved indications, but Medicare may also provide reimbursement for additional, so-called off-label, uses. Data adapted.64
Abbreviations: FDA, US Food and Drug Administration; HCPCS, Healthcare Common Procedure Coding System; NSCLC, non–small-cell lung cancer.