Parsabiv® is reimbursed as part of the ESRD bundle in 20211
The Transitional Drug Add-on Payment Adjustment (TDAPA) was established to make innovative therapies accessible to CMS beneficiaries.2
Parsabiv® was available as an add-on payment under TDAPA in 2020.2
Reimbursement changes support your clinical decisions to use Parsabiv®
The bundle addition reflects the average national calcimimetic utilization* under TDAPA.
Your actual reimbursement will be affected by geography, wages, patient average case mix, volume, and other adjustments.
National Parsabiv® utilization contributed to 83%, or $8.39,† of the calcimimetic valuation.‡
ESRD = end-stage renal disease; CMS = Centers for Medicare & Medicaid Service; PPS = prospective payment system.
*CMS final rule is based on Q3 2018 through Q4 2019 total US calcimimetic utilization. †After 1.6% market basket increase. ‡CMS final rule is based on Q3 2018 through Q4 2019 total US calcimimetic utilization and Q4 2020 ASP+0. Data used to calculate the Parsabiv® (etelcalcetide) cost per treatment: (Parsabiv® milligrams × Q4 2020 ASP + cinacalcet milligrams × Q4 2020 ASP) = total valuation of calcimimetics ÷ total number of dialysis treatments. The information provided in this material is of a general nature and for informational purposes only. Coding and coverage policies change periodically and often without warning. The responsibility to determine coverage and reimbursement parameters, and appropriate coding for a particular patient and/or procedure, is always the responsibility of the provider or physician. The information provided here should in no way be considered a guarantee of coverage or reimbursement for any product or service. ASP = average sales price.
Parsabiv® can fit within your facility operations
Providers will receive the same amount of additional Parsabiv® reimbursement for every Medicare FFS patient, whether they are taking Parsabiv® or not
Avoids specialty pharmacy hassles and costs
There are no changes to billing workflow that would require additional staff training/time. Parsabiv® will simply be reimbursed as part of the bundle
- While they are not required to adopt the bundle payment methodology, they are responsible for covering calcimimetics for clinically appropriate patients. Amgen believes it would be appropriate for Medicare Advantage Organizations to adopt a payment methodology similar to the CMS 2021 bundle addition to account for the cost of calcimimetics not previously covered in Part B
- Medicaid coverage varies by state. Check with your State Medicaid Office to understand coverage and requirements specific to your state
- Commercial coverage and reimbursement will vary. Contact your contracted payer or parent organization to determine how Parsabiv® will be covered under your specific contract terms; contract amendments may be necessary.
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