Oral anticancer drugs are covered under the oral anticancer drug benefit [Social Security Act §1861(s)(2)(Q)]. Oral Antiemetic Drugs are covered under the Oral Antiemetic Drug benefit (Social Security Act §1861(s)(2)(T)).

Coverage

• Aprepitant for Chemotherapy-Induced EMESIS (110.18) National Coverage Determination (NCD)
• Oral Anticancer Drugs Local Coverage Determination (LCD) and Policy Article [PDF]
• Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) LCD and Policy Article [PDF]

Documentation

• Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to help obtain documentation
• Oral Anticancer Drugs Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation

Fees

• Oral Anti-Cancer Drug Fees
• Oral Anti-Emetic Drug, Pharmacy Supply and Dispensing Fees
• Pricing

Tips

Topic	Details
New ICD 10-Codes	NCD110.18 Aprepitant for Chemo-Induced Emesis has been updated. Added ICD-10 codes D04.111, D04.112, D04.121, and D04.122. See CMS Medicare Learning Network (MLN) Matters (MM)10859 for details.

 

Resources

• CMS Internet Only Manual (IOM), Publication 100-02, Chapter 15 - Self-Administered Drugs and Biologicals
• CMS IOM, Publication 100-04, Chapter 17 - Oral Cancer Drugs and Oral Anti-Emetic Drugs
• CMS Medicare Learning Network (MLN) Matters (MM)9386 - Authoritative Sources Used in Determination of "Medically-Accepted Indication" of Drugs and Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimen
• National Drug Codes for Oral Anti-Cancer Drugs (OACD)
• NCPDP - NCPDP Companion Document