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New Bioverativ Blood Factor NDC Medi-Cal Benefits

August 14, 2018

Bioverativ has introduced new National Drug Codes (NDCs) for each of their Alprolix and Eloctate products. The effective dates for each NDC with their associated HCPCS code are listed below.

Effective for dates of service on or after July 1, 2018, the following NDCs for HCPCS code J7201 (injection, Factor IX, Fc fusion protein [recombinant], Alprolix, per IU) are Medi-Cal benefits and eligible for reimbursement.

NDC Labeler Name
71104096601 ALPROLIX 250 IU
71104091101 ALPROLIX 500 IU
71104092201 ALPROLIX 1000 IU
71104093301 ALPROLIX 2000 IU
71104094401 ALPROLIX 3000 IU
71104097701 ALPROLIX 4000 IU

Effective for dates of service on or after April 1, 2018, the following NDCs for HCPCS code J7205 (injection, factor VIII, Fc fusion protein [recombinant], per IU) are Medi-Cal benefits and eligible for reimbursement.

NDC Labeler Name
71104080201 ELOCTATE 500 IU
71104080301 ELOCTATE 750 IU
71104080501 ELOCTATE 1500 IU
71104080701 ELOCTATE 3000 IU
71104080901 ELOCTATE 5000 IU

Effective for dates of service on or after July 1, 2018, the following NDCs for HCPCS code J7205 are Medi-Cal benefits and eligible for reimbursement.

NDC Labeler Name
71104080101 ELOCTATE 250 IU
71104080401 ELOCTATE 1000 IU
71104080601 ELOCTATE 2000 IU
71104080801 ELOCTATE 4000 IU
71104081001 ELOCTATE 6000 IU

Providers with denied claims affected by this change must resubmit the claims to receive payment.