Access to EXPAREL Continues to Grow for You and Your Patients
Access Overview
EXPAREL Is Separately Reimbursed for ~150 Million Lives Nationwide1
Now separately reimbursed by all major national payers including Aetna, Cigna Healthcare, Humana, and UnitedHealthcare1
Separate reimbursement for Medicare patients (via the NOPAIN Act) has expanded EXPAREL coverage for millions of patients2-4
Major national commercial plans also reimburse EXPAREL outside the bundled procedure cost, providing additional cost offsets4
Permanent, product-specific codes (J0666)* support predictable reimbursement in ASC and HOPD settings2,3,5
Partnerships with major GPOs ensure systems have access to contract pricing, which will reduce overall net costs
Reimbursement is expanding for EXPAREL across commercial and Medicare plans
*Reimbursement is provided as ASP+6%, meaning an additional 6% above the average sales price of EXPAREL.2,3
ASC, ambulatory surgical center; ASP, average sales price; GPO, group purchasing organization; HOPD, hospital outpatient department; NOPAIN, Non-Opioids Prevent Addiction in the Nation.
The NOPAIN Act2
Medicare Is Required to Reimburse for Qualifying Non-Opioid Alternatives, Like EXPAREL, Across All Outpatient Settings*
Expanded access to non-opioids for postsurgical pain management
Provides reimbursement for drugs and devices that have demonstrated the ability to reduce or avoid intraoperative or postoperative opioid use, including EXPAREL
Reinforces Congress and CMS's commitment to ensuring access to approved non-opioid treatments for postsurgical pain management
See How the NOPAIN Act Provides Additional Medicare Reimbursement for EXPAREL
Understanding Medicare Reimbursement
*Appropriate outpatient settings per the NOPAIN Act were defined as ASCs and HOPDs.
CMS, Centers for Medicare & Medicaid Services.
Coverage Support
EXPAREL Provider Services
The Provider Services Team Offers Comprehensive Support for Your Practice and Patients
- Benefits Investigation
Identifies patient coverage and cost share (if any) and confirms whether buy-and-bill is required - Coding and Billing
Provides key coding and billing information and training while helping navigate issues that may arise - Prior Authorization (PA)
Contextualizes coverage requirements, such as a PA, and the paperwork needed
- Appeals Support
Guides practices through the appeals process if a PA is denied, including what supporting documentation is required. A field reimbursement manager can also provide support with access and reimbursement - Explanation of Benefits (EOB) Warehouse
Helps practices build billing and reimbursement confidence, establish clear payer reimbursement expectations, and identify and appeal EOB errors like underpayments, denials, and inconsistencies
Support Is Available Today:
Call:
1-844-462-6225
Enroll Online:
www.EXPARELsupport.com
ACCESS LETTER TEMPLATES
are available
to help support coverage conversations with payers.
Coding & Billing
Permanent Codes Are Available to Support Reimbursement for EXPAREL
For Procedures Performed in
Outpatient Settings5
CMS has assigned a permanent, product-specific billing code for EXPAREL: J0666
J0666 1 mg = 1 unit
For Dental Procedures6,7
D9613 is defined as the infiltration of a sustained-release therapeutic drug, per quadrant, which allows for EXPAREL reimbursement in oral surgery procedures
TIP: Proper documentation is key to support timely reimbursement. Download the Operative Notes Tip Sheet to help track the use of EXPAREL.
EXPAREL 20 mL (266 mg) and 10 mL (133 mg) Are Available to Order in Cartons of 4 or 10 Vials.
As of March 20, 2017, there are 4 SKUs of EXPAREL available.
| Configuration | Dose/vial size | NDC # |
|---|---|---|
| Carton of 10 vials | EXPAREL 266 mg/20 mL | 65250-266-09 |
| Carton of 4 vials | EXPAREL 266 mg/20 mL | 65250-266-04 |
| Carton of 10 vials | EXPAREL 133 mg/10 mL | 65250-133-09 |
| Carton of 4 vials | EXPAREL 133 mg/10 mL | 65250-133-04 |
CMS, Centers for Medicare & Medicaid Services; NDC, National Drug Code; SKU, stock-keeping unit.
Ordering EXPAREL
First-Time Order Information
MULTIDISCIPLINARY COLLABORATION
can help support EXPAREL access.
Contact your Pacira Account Manager to help support cross-functional collaboration in your organization.