Bristol Myers Squibb is committed to helping appropriate patients get access to our
medications by providing access and reimbursement support services.

This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

Billing and
Diagnosis Codes

The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

Reimbursement and Coding Guide for THALOMID
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Type a keyword to find a specific NDC or ICD-10 code for Multiple Myeloma or Leprosy
National Drug Codes (NDC)1 Issued by the FDA
59572-0205-17

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50 mg/individual blister packs of 1 capsule

59572-0205-14

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50 mg/individual blister packs of 28 capsules

59572-0210-15

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100 mg/individual blister packs of 28 capsules

59572-0215-13

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150 mg/individual blister packs of 28 capsules

59572-0220-16

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200 mg/individual blister packs of 28 capsules

International Classification of Diseases, Tenth Revision, Clinical Modification Diagnosis Codes (ICD-10-CM)
Multiple Myeloma ICD-10 Codes2
C90.0

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Multiple myeloma and malignant plasma cell neoplasm

Leprosy (Hansen’s disease) ICD-10 Codes2
A30

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Leprosy (Hansen’s disease)

A30.0

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Indeterminate leprosy

A30.1

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Tuberculoid leprosy

A30.2

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Borderline tuberculoid leprosy

A30.3

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Borderline leprosy

A30.4

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Borderline lepromatous leprosy

A30.5

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Lepromatous leprosy

A30.8

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Other forms of leprosy

A30.9

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Leprosy, unspecified

Coding for THALOMID is dependent on the insurer and the care setting in which the drug will be administered. Oncology practices need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer requirements.

Please see U.S. Full Prescribing Information for THALOMID, including Boxed WARNINGS.

Prescribers and pharmacies must be certified with the THALOMID REMS® program by enrolling and complying with the REMS requirements; pharmacies must only dispense to patients who are authorized to received THALOMID. The REMS-Pharmacy Network list includes specialty pharmacies that are contracted to fill prescriptions for restricted distribution programs for Bristol Myers Squibb.

Specialty Pharmacy Phone Orders Fax Orders
ACRO Pharmaceutical Services 1-800-906-7798 1-877-381-3806
Accredo Specialty Pharmacy 1-877-732-3431 1-800-590-1021
Advanced Care Scripts (ACS) 1-877-985-6337 1-866-679-7131
Aetna Specialty Pharmacy 1-866-782-2779 1-860-900-7994
AllianceRx Walgreens Prime 1-888-347-3416 1-877-231-8302
Amber Pharmacy 1-888-763-5517 1-402-896-4862
Avella Specialty Pharmacy 1-877-546-5779 1-877-546-5780
Biologics Inc. 1-800-850-4306 1-800-823-4506
BioPlus Specialty Pharmacy 1-888-292-0744 1-800-269-5493
BriovaRX, an OptumRx® Specialty Pharmacy 1-888-432-2797 1-866-306-5231
Cardinal Health Specialty Pharmacy 1-888-662-6779 1-877-800-4790
CareMed Specialty Pharmacy 1-877-227-3405 1-877-542-2731
CIGNA Specialty Pharmacy 1-800-351-3606 1-800-351-3616
CVS Specialty Pharmacy Customer Care 1-800-237-2767 1-800-323-2445
Diplomat Specialty Pharmacy 1-877-977-9118 1-800-550-6272
Exactus Pharmacy Solutions, Inc. (WellCare) 1-866-458-9246 1-866-458-9245
Humana Specialty Pharmacy 1-800-486-2668 1-877-405-7940
Kroger Specialty Pharmacy 1-888-315-3395 1-888-315-3270
Magellan Rx Pharmacy/ICORE 1-866-554-2673 1-866-364-2673
McKesson Specialty Pharmacy: Veterans Affairs Rx service 1-855-637-9433 1-855-637-9446
Onco369 1-877-662-6633 1-877-662-6355
TNH Advanced Specialty Pharmacy 1-877-849-9591 1-855-356-1096
Upstate Pharmacy 1-800-314-4655 1-800-314-7756
US Bioservices 1-877-757-0667 1-888-899-0067

Above information is accurate as of 05/2021.

The THALOMID distribution program includes extended payment terms to Bristol Myers Squibb authorized THALOMID distributors. Healthcare providers and institutions should contact their THALOMID distributor to understand specific payment terms that may be available to them from their distributor.

Please see U.S. Full Prescribing Information for THALOMID, including Boxed WARNINGS.

FDA Approval Letters as Posted by the FDA:

For the treatment of patients with newly diagnosed multiple myeloma in combination with dexamethasone
View Letter

For the acute treatment of cutaneous manifestations of moderate to severe ENL (erythema nodosum leprosum)
View Letter

THALOMID is not indicated as monotherapy for such ENL treatment in the presence of moderate to severe neuritis.

For maintenance therapy for the prevention and suppression of the cutaneous manifestations of ENL recurrence
View Letter

Please see U.S. Full Prescribing Information for THALOMID, including Boxed WARNINGS.

*Healthcare providers should code healthcare claims based upon the service that is rendered, the patient’s medical record, the coding requirements of each health insurer, and best coding practices. Coding guidance provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable coding guidance and standards. All of the coding information presented by this website is applicable to outpatient procedures only.

References:

  1. THALOMID (thalidomide) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company.
  2. American Medical Association. 2020 ICD-10-CM: The Complete Official Codebook. Chicago, IL: American Medical Association; 2020.

The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.

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©2021 Bristol-Myers Squibb Company. All rights reserved. Access Support is a registered trademark of Bristol-Myers Squibb Company. THALOMID® and THALOMID REMS® are registered trademarks of Celgene Corporation, a Bristol Myers Squibb company.

Use of the information on this site is subject to the terms of our Legal Notice and Privacy Statement. The coding, coverage, and payment information contained within this website is current as of 05/21.

2015-US-2100002 05/21