Pacira BioSciences Announces New Product-Specific J-Code for EXPAREL Effective January 1, 2025
Pacira BioSciences (NASDAQ: PCRX) announced that the Centers for Medicare and Medicaid Services (CMS) has established a new product-specific J-code (J0666) for EXPAREL, effective January 1, 2025. This J-code will replace the current C-code (C9290) and is expected to standardize and streamline billing and reimbursement for the non-opioid pain therapy.
The new J-code will provide reimbursement for EXPAREL in office settings and office-based surgeries, in addition to the separate CMS reimbursement in outpatient settings under the NOPAIN implementation. This development is significant as J-codes are widely recognized by commercial insurance plans, Medicare, and other government payers, potentially increasing clinician access to EXPAREL across various care settings and payer types.
Pacira BioSciences (NASDAQ: PCRX) ha annunciato che i Centers for Medicare e Medicaid Services (CMS) hanno istituito un nuovo codice J specifico per il prodotto (J0666) per EXPAREL, con effetto dal 1 gennaio 2025. Questo codice J sostituirà l'attuale codice C (C9290) e si prevede che standardizzi e semplifichi la fatturazione e il rimborso per la terapia non oppioide per il dolore.
Il nuovo codice J offrirà rimborso per EXPAREL negli ambulatori e nelle chirurgie ambulatoriali, oltre al rimborso separato dei CMS nelle strutture per pazienti esterni sotto l'implementazione di NOPAIN. Questo sviluppo è significativo poiché i codici J sono ampiamente riconosciuti dai piani di assicurazione commerciali, Medicare e altri pagatori governativi, aumentando potenzialmente l'accesso dei clinici a EXPAREL in vari contesti di cura e tipi di pagatori.
Pacira BioSciences (NASDAQ: PCRX) anunció que los Centros de Servicios de Medicare y Medicaid (CMS) han establecido un nuevo código J específico para el producto (J0666) para EXPAREL, con efecto a partir del 1 de enero de 2025. Este código J reemplazará el código C actual (C9290) y se espera que estandarice y simplifique la facturación y el reembolso para la terapia del dolor no opioide.
El nuevo código J proporcionará reembolso para EXPAREL en consultorios y cirugías ambulatorias, además del reembolso separado de CMS en entornos ambulatorios bajo la implementación de NOPAIN. Este desarrollo es significativo, ya que los códigos J son ampliamente reconocidos por planes de seguros comerciales, Medicare y otros pagadores gubernamentales, lo que potencialmente aumentará el acceso de los clínicos a EXPAREL en varios entornos de atención y tipos de pagadores.
Pacira BioSciences (NASDAQ: PCRX)는 메디케어 및 메디케이드 서비스 센터(CMS)가 EXPAREL에 대한 새로운 제품 전용 J코드(J0666)를 2025년 1월 1일부터 시행한다고 발표했습니다. 이 J코드는 현재 C코드(C9290)를 대체하며, 비마약성 통증 치료의 청구 및 환급을 표준화하고 간소화할 것으로 예상됩니다.
새로운 J코드는 NOPAIN 시행 하에 외래 환자 환경에서 CMS의 별도 환급과 함께, 진료 환경 및 외래 수술에서 EXPAREL에 대한 환급을 제공합니다. 이 발전은 J코드가 상업 보험 계획, 메디케어 및 기타 정부 지급자들에 의해 널리 인식되므로, 다양한 치료 환경 및 지급자 유형에서 EXPAREL에 대한 임상의의 접근성을 증가시킬 수 있습니다.
Pacira BioSciences (NASDAQ: PCRX) a annoncé que les Centers for Medicare et Medicaid Services (CMS) ont établi un nouveau code J spécifique au produit (J0666) pour EXPAREL, prenant effet le 1er janvier 2025. Ce code J remplacera l'actuel code C (C9290) et devrait standardiser et simplifier la facturation et le remboursement pour la thérapie anti-douleur non-opioïde.
Le nouveau code J permettra le remboursement d'EXPAREL dans les cabinets médicaux et les chirurgies ambulatoires, en plus du remboursement séparé du CMS dans les environnements de soins ambulatoires dans le cadre de l'implémentation de NOPAIN. Ce développement est significatif, car les codes J sont largement reconnus par les plans d'assurance commerciaux, Medicare et d'autres payeurs gouvernementaux, ce qui pourrait augmenter l'accès des cliniciens à EXPAREL dans divers contextes de soins et types de payeurs.
Pacira BioSciences (NASDAQ: PCRX) gab bekannt, dass die Centers for Medicare und Medicaid Services (CMS) einen neuen produktbezogenen J-Code (J0666) für EXPAREL eingerichtet haben, der am 1. Januar 2025 in Kraft tritt. Dieser J-Code wird den aktuellen C-Code (C9290) ersetzen und es wird erwartet, dass er die Abrechnung und Erstattung für die nicht-opioide Schmerztherapie standardisiert und vereinfacht.
Der neue J-Code wird die Erstattung für EXPAREL in Praxen und ambulanten Operationen ermöglichen, zusätzlich zur separaten CMS-Erstattung in ambulanten Einrichtungen im Rahmen der NOPAIN-Implementierung. Diese Entwicklung ist bedeutend, da J-Codes von kommerziellen Versicherungsplänen, Medicare und anderen staatlichen Kostenträgern weit anerkannt sind, was potenziell den Zugang der Kliniker zu EXPAREL in verschiedenen Versorgungseinrichtungen und Kostenträgerarten erhöhen könnte.
- New product-specific J-code (J0666) established for EXPAREL, effective January 1, 2025
- J-code expected to streamline billing and reimbursement processes
- Potential for increased coverage by commercial payers
- Enhanced clinician access to EXPAREL across various care settings and payer types
- Complements upcoming NOPAIN reimbursement in outpatient settings
- None.
Insights
The new J-code for EXPAREL represents a significant development for Pacira BioSciences. This administrative change will likely have positive implications for the company's revenue and market penetration:
- Streamlined billing process: The J-code will simplify reimbursement procedures, potentially reducing administrative burdens and accelerating payment cycles.
- Broader insurance coverage: J-codes are more widely recognized by commercial insurers, which could expand EXPAREL's patient base and market share.
- Synergy with NOPAIN Act: Combined with the separate CMS reimbursement under NOPAIN, this change creates a more favorable reimbursement environment across various care settings.
- Potential for increased adoption: Easier reimbursement and broader coverage may encourage more healthcare providers to use EXPAREL, particularly in outpatient and office-based settings.
While the impact won't be immediate (effective January 2025), this change positions EXPAREL for potential growth in a key market segment. Investors should monitor how this translates to revenue growth and market share gains in the coming years.
-- New J-code issued by the Centers for Medicare and Medicaid Services expected to standardize and streamline billing and reimbursement --
TAMPA, Fla., Oct. 03, 2024 (GLOBE NEWSWIRE) -- Pacira BioSciences, Inc. (NASDAQ: PCRX), the industry leader in the delivery of innovative, non-opioid pain therapies, today announced that the Centers for Medicare and Medicaid Services (CMS) has established a permanent product-specific Healthcare Common Procedure Coding System (HCPCS) J-code for EXPAREL® (bupivacaine liposome injectable suspension). The new J-code for EXPAREL, J0666, becomes effective January 1, 2025, and will supersede the current C-code (C9290), which has been in place since 2019.
In addition to the separate CMS reimbursement EXPAREL will receive in outpatient settings with the implementation of NOPAIN in January 2025, this new J-code will also provide reimbursement when EXPAREL is used in the office setting and for office-based surgeries.
J-codes are reimbursement codes used by commercial insurance plans, Medicare, Medicare Advantage, and other government payers for Medicare Part B drugs like EXPAREL. Claims submission and payment are standardized with a J-code, facilitating and streamlining billing and reimbursement. In addition, some commercial insurers require a J-code for payment.
“We are pleased that EXPAREL will have its own product-specific J-code beginning on January 1, 2025,” said Frank D. Lee, chief executive officer of Pacira. “In addition to streamlining the reimbursement billing and coding process at large, a J-code is also more likely to be recognized and covered by commercial payers—a growing portion of the EXPAREL patient population. This, combined with the impending reimbursement from NOPAIN, is particularly important toward increasing clinician access to EXPAREL across sites of care and payer types, offering them the enhanced ability to offer a best-in-class option for achieving long-lasting non-opioid pain control with an increased ability to transition procedures to outpatient settings.”
EXPAREL is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older and regional analgesia in adults via an interscalene brachial plexus nerve block, sciatic nerve block in the popliteal fossa, and an adductor canal block. Safety and efficacy have not been established in other nerve blocks. It has been used in over 15 million patients across the United States to date.
About Pacira BioSciences
Pacira BioSciences delivers innovative, non-opioid pain therapies to transform the lives of patients. Pacira has three commercial-stage non-opioid treatments: EXPAREL® (bupivacaine liposome injectable suspension), a long-acting local analgesic currently approved for infiltration, fascial plane block, and as an interscalene brachial plexus nerve block for postsurgical pain management; ZILRETTA® (triamcinolone acetonide extended-release injectable suspension), an extended-release, intra-articular injection indicated for the management of osteoarthritis knee pain; and ioveraº®, a novel, handheld device for delivering immediate, long-acting, drug-free pain control using precise, controlled doses of cold temperature to a targeted nerve. The company is also advancing the development of PCRX-201, a novel locally administered gene therapy with the potential to treat large prevalent diseases like osteoarthritis. To learn more about Pacira, visit www.pacira.com.
About EXPAREL®
EXPAREL (bupivacaine liposome injectable suspension) is indicated to produce postsurgical local analgesia via infiltration in patients aged 6 years and older, and postsurgical regional analgesia via an interscalene brachial plexus block in adults, a sciatic nerve block in the popliteal fossa in adults, and an adductor canal block in adults. The safety and effectiveness of EXPAREL have not been established to produce postsurgical regional analgesia via other nerve blocks besides an interscalene brachial plexus nerve block, a sciatic nerve block in the popliteal fossa, or an adductor canal block. The product combines bupivacaine with multivesicular liposomes, a proven product delivery technology that delivers medication over a desired time period. EXPAREL represents the first and only multivesicular liposome local anesthetic that can be utilized in the peri- or postsurgical setting. By utilizing the multivesicular liposome platform, a single dose of EXPAREL delivers bupivacaine over time, providing significant reductions in cumulative pain scores with up to a 78 percent decrease in opioid consumption; the clinical benefit of the opioid reduction was not demonstrated. Additional information is available at www.EXPAREL.com.
Forward-Looking Statements
Any statements in this press release about Pacira’s future expectations, plans, trends, outlook, projections and prospects, and other statements containing the words “anticipate,” “believe,” “can,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “project,” “should,” “will,” “would,” and similar expressions, constitute forward-looking statements within the meaning of Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and the Private Securities Litigation Reform Act of 1995, including, without limitation, statements related to our intellectual property, our growth and future operating results and trends, our strategy, plans, objectives, expectations (financial or otherwise) and intentions, future financial results and growth potential, including our plans with respect to the repayment of our indebtedness, anticipated product portfolio, development programs, patent terms, development of products, strategic alliances, plans with respect to the Non-Opioids Prevent Addiction in the Nation (“NOPAIN”) Act and other statements that are not historical facts. For this purpose, any statement that is not a statement of historical fact should be considered a forward-looking statement. We cannot assure you that our estimates, assumptions and expectations will prove to have been correct. Actual results may differ materially from those indicated by such forward-looking statements as a result of various important factors, including risks relating to, among others: the integration of our new chief executive officer; risks associated with acquisitions, such as the risk that the acquired businesses will not be integrated successfully, that such integration may be more difficult, time-consuming or costly than expected or that the expected benefits of the transaction will not occur; our manufacturing and supply chain, global and U.S. economic conditions (including inflation and rising interest rates), and our business, including our revenues, financial condition, cash flow and results of operations; the success of our sales and manufacturing efforts in support of the commercialization of EXPAREL, ZILRETTA and iovera°; the rate and degree of market acceptance of EXPAREL, ZILRETTA and iovera°; the size and growth of the potential markets for EXPAREL, ZILRETTA and iovera° and our ability to serve those markets; our plans to expand the use of EXPAREL, ZILRETTA and iovera° to additional indications and opportunities, and the timing and success of any related clinical trials for EXPAREL, ZILRETTA and iovera°; the commercial success of EXPAREL, ZILRETTA and iovera°; the related timing and success of U.S. Food and Drug Administration supplemental New Drug Applications and premarket notification 510(k)s; the related timing and success of European Medicines Agency Marketing Authorization Applications; our plans to evaluate, develop and pursue additional product candidates utilizing our proprietary multivesicular liposome (“pMVL”) drug delivery technology; the approval of the commercialization of our products in other jurisdictions; clinical trials in support of an existing or potential pMVL-based product; our commercialization and marketing capabilities; our ability to successfully complete capital projects; the outcome of any litigation; the ability to successfully integrate any future acquisitions into our existing business; the recoverability of our deferred tax assets; assumptions associated with contingent consideration payments; the anticipated funding or benefits of our share repurchase program; and factors discussed in the “Risk Factors” of our most recent Annual Report on Form 10-K and in other filings that we periodically make with the Securities and Exchange Commission (the “SEC”). In addition, the forward-looking statements included in this press release represent our views as of the date of this press release. Important factors could cause actual results to differ materially from those indicated or implied by forward-looking statements, and as such we anticipate that subsequent events and developments will cause our views to change. Except as required by applicable law, we undertake no intention or obligation to update or revise any forward-looking statements, whether as a result of new information, future events or otherwise, and readers should not rely on these forward-looking statements as representing our views as of any date subsequent to the date of this press release.
FAQ
What is the new J-code for EXPAREL and when does it become effective?
How will the new J-code for EXPAREL (PCRX) affect reimbursement?
What is EXPAREL indicated for according to the Pacira BioSciences (PCRX) press release?
How many patients have used EXPAREL in the United States to date?
