Associate Director ViiV Healthcare Kalamazoo, United States
Background: FDA approval of Cabotegravir (CAB)+Rilpivirine (RPV) long-acting (LA) for treatment and CAB LA for HIV pre-exposure prophylaxis (PrEP), in January and December 2021, respectively, marked the beginning of availability of LA regimens for HIV treatment and prevention in the United States. J-codes are HCPCS Level II procedure codes, for which applications are received quarterly by The Centers for Medicare & Medicaid Services (CMS) from Market Authorization Holders (MAH), and generally become effective approximately six months after application.
Objectives: To identify trends in temporary and non-specific procedure codes used for CAB+RPV LA and CAB LA for PrEP and track the uptake of the specific procedure codes in administrative claims data.
Methods: This was a retrospective analysis of pre-adjudicated professional and institutional medical claims from IQVIA Anonymized Patient Level Data (APLD) Dx data* from 01APR2021-31OCT2022. CAB+RPV LA administration was identified by specific HCPCS code (J0741; effective 01OCT2021), temporary HCPCS code (C9077) or one non-specific HCPCS codes (J3490, J3590) along with a specific NDC code (49702-0240-15 or 49702-0253-15). CAB LA for PrEP was identified by specific HCPCS code (J0739; effective 01JUL2022) or one non-specific code (J3490, J3590, C9399) along with the specific NDC code (49702-0264-23). Counts of HCPCS procedure codes were calculated by type of code and month of administration from 01APR2021-31OCT2022 for CAB+RPV LA and 01FEB2022-31OCT2022 for CAB LA for PrEP.
*Note: This is based on information licensed from IQVIA APLD Dx for the period 01APR2021-31OCT2022 reflecting estimates of real-world activity. All rights reserved.
Results: There were a total of 8,248 administrations of CAB+RPV LA identified from 01APR2021-31OCT2022. The non-specific code, J3490 was the first code to be used for CAB+RPV starting in APR 2021 and use of the temporary code, C9077 was first identified in JUL2021. Both increased in use through SEP2021 after which the specific code, J0741 increased from OCT2021 through OCT2022. There were a total of 444 administrations of CAB LA for PrEP documented from 01FEB2022-31OCT2022. The non-specific code, J3490 was the first code to be used for CAB LA for PrEP starting in FEB2022 followed by the non-specific code, C9399 in MAY2022. J3490 code usage increased until JUL2022 after which the specific code, J0739 increased through OCT2022.
Conclusions: Accurate identification of both CAB+RPV LA and CAB LA for PrEP requires the use of either a specific HCPCS code or a combination of non-specific HCPCS code and a specific NDC code. J-codes serve a critical role for both reimbursement and research purposes.
