Drugs Used for the Treatment of Select Malignancies and Their Associated Codes and Pricing

These detailed tables of codes and pricing related to drugs used to treat breast cancer, lung cancer, gynecologic malignancies, and hematologic malignancies are intended to assist practice managers, other healthcare providers, and payers to ensure the proper use of coding and billing information associated with the treatment of their patients.

Table 1HCPCS Codes and Prices

Breast Cancer

Generic (brand) name
gemcitabine in 0.9% sodium chloride injection (Infugem)
Indication(s)
MBC
HCPCS code/description
J9199a-injection, Infugem 200 mg
Manufacturer
Sun Pharmaceuticals
WAC per HCPCS unit
$76.00
AWP per HCPCS unit
$91.20
Generic (brand) name
pembrolizumab injection (Keytruda)
Indication(s)
classical HL; primary mediastinal large B-cell lymphoma
HCPCS code/description
J9271-injection, pembrolizumab 1 mg
Manufacturer
Merck
WAC per HCPCS unit
$48.62
AWP per HCPCS unit
$58.34
Generic (brand) name
rituximab-abbs injection (Truxima)
Indication(s)
CLL; NHL
HCPCS code/description
Q5115-injection Truxima 10 mg
Manufacturer
Cephalon
WAC per HCPCS unit
$84.56
AWP per HCPCS unit
$101.47
Generic (brand) name
rituximab and hyaluronidase, human recombinant (Rituxan Hycela)
Indication(s)
CLL; DLBCL; FL
HCPCS code/description
J9311-injection rituximab, hyaluronidase 10 mg
Manufacturer
Genentech
WAC per HCPCS unit
$46.98
AWP per HCPCS unit
$56.37
Generic (brand) name
trastuzumab-pkrb injection (Herzuma)
Indication(s)
HER2-overexpressing breast cancer
HCPCS code/description
Q5113-injection, trastuzumab-pkrb, biosimilar, 10 mg
Manufacturer
Teva
WAC per HCPCS unit
$93.50
AWP per HCPCS unit
$112.20

Lung Cancer

Generic (brand) name
durvalumab injection (Imfinzi)
Indication(s)
extensive-stage SCLC; NSCLC
HCPCS code/description
J9173-injection, durvalumab, 10 mg
Manufacturer
AstraZeneca
WAC per HCPCS unit
$73.30
AWP per HCPCS unit
$87.96
Generic (brand) name
gemcitabine in 0.9% sodium chloride injection (Infugem)
Indication(s)
NSCLC
HCPCS code/description
J9199a-injection, Infugem 200 mg
Manufacturer
Sun Pharmaceuticals
WAC per HCPCS unit
$76.00
AWP per HCPCS unit
$91.20
Generic (brand) name
nivolumab injection (Opdivo)
Indication(s)
NSCLC; SCLC
HCPCS code/description
J9299-injection, nivolumab 1 mg
Manufacturer
Bristol Myers Squibb
WAC per HCPCS unit
$27.42
AWP per HCPCS unit
$32.90
Generic (brand) name
pembrolizumab injection (Keytruda)
Indication(s)
NSCLC; SCLC
HCPCS code/description
J9271-injection, pembrolizumab, 1 mg
Manufacturer
Merck
WAC per HCPCS unit
$48.62
AWP per HCPCS unit
$58.34

Gynecologic Malignancies

Generic (brand) name
gemcitabine in 0.9% sodium chloride injection (Infugem)
Indication(s)
advanced ovarian cancer
HCPCS code/description
J9199a-injection, Infugem, 200 mg
Manufacturer
Sun Pharmaceuticals
WAC per HCPCS unit
$76.00
AWP per HCPCS unit
$91.20
Generic (brand) name
pembrolizumab injection (Keytruda)
Indication(s)
advanced endometrial cancer; recurrent or metastatic cervical cancer
HCPCS code/description
J9271-injection, pembrolizumab 1 mg
Manufacturer
Merck
WAC per HCPCS unit
$48.62
AWP per HCPCS unit
$58.34

Hematologic Malignancies

Generic (brand) name
daratumumab injection (Darzalex)
Indication(s)
MM
HCPCS code/description
J9145-injection, daratumumab 10 mg
Manufacturer
Janssen Biotech
WAC per HCPCS unit
$55.57
AWP per HCPCS unit
$66.68
Generic (brand) name
moxetumomab pasudotox-tdfk (Lumoxiti)
Indication(s)
relapsed or refractory hairy-cell leukemia
HCPCS code/description
J9313-injection, moxetumomab pasudotox-tdfk, 0.01 mg
Manufacturer
AstraZeneca
WAC per HCPCS unit
$21.15
AWP per HCPCS unit
$25.37
Generic (brand) name
nivolumab injection (Opdivo)
Indication(s)
classical HL
HCPCS code/description
J9299-injection, nivolumab 1 mg
Manufacturer
Bristol Myers Squibb
WAC per HCPCS unit
$27.42
AWP per HCPCS unit
$32.90
aDeactivation date for HCPCS code J9199 (Infugem 200 mg) is June 30, 2020. Activation date for HCPCS code J9198 (Infugem 100 mg) is July 1, 2020.
AWP indicates average wholesale price; CLL, chronic lymphocytic leukemia; DLBCL, diffuse large B-cell lymphoma; FL, follicular lymphoma; HCPCS; Healthcare Common Procedure Coding System; HL, Hodgkin lymphoma; MBC, metastatic breast cancer; MM, multiple myeloma; NHL, non-Hodgkin lymphoma; NSCLC, non–small-cell lung cancer; SCLC, small-cell lung cancer; WAC, wholesale acquisition cost.

Table 2NDC Codes and Prices

Breast Cancer

Generic (brand) name
talazoparib (Talzenna) capsules
Indication(s)
locally advanced or MBC
Strength
0.25 mg
NDC code
0069-0296-30
Manufacturer
Pfizer
WAC per unit
$170.10
AWP per unit
$204.12
Generic (brand) name
talazoparib (Talzenna) capsules
Indication(s)
locally advanced or MBC
Strength
1 mg
NDC code
0069-1195-30
Manufacturer
Pfizer
WAC per unit
$510.30
AWP per unit
$612.36
Generic (brand) name
tucatinib (Tukysa) tablets
Indication(s)
MBC
Strength
50 mg
NDC code
51144-001-60
Manufacturer
Seattle Genetics
WAC per unit
$76.67
AWP per unit
$92.00
Generic (brand) name
tucatinib (Tukysa) tablets
Indication(s)
MBC
Strength
150 mg
NDC code
51144-002-12 (120 tablets)
51144-002-60 (60 tablets)
Manufacturer
Seattle Genetics
WAC per unit
$154.17
AWP per unit
$185.00

Lung Cancer

Generic (brand) name
capmatinib (Tabrecta) tablets
Indication(s)
metastatic NSCLC
Strength
150 mg
NDC code
00078-0709-56
Manufacturer
Novartis
WAC per unit
$160.27
AWP per unit
$192.32
Generic (brand) name
capmatinib (Tabrecta) tablets
Indication(s)
metastatic NSCLC
Strength
200 mg
NDC code
00078-0716-56
Manufacturer
Novartis
WAC per unit
$160.27
AWP per unit
$192.32
Generic (brand) name
dacomitinib (Vizimpro) tablets
Indication(s)
metastatic NSCLC
Strength
15 mg
NDC code
00069-0197-30
Manufacturer
Pfizer
WAC per unit
$434.00
AWP per unit
$520.80
Generic (brand) name
dacomitinib (Vizimpro) tablets
Indication(s)
metastatic NSCLC
Strength
30 mg
NDC code
00069-1198-30
Manufacturer
Pfizer
WAC per unit
$434.00
AWP per unit
$520.80
Generic (brand) name
dacomitinib (Vizimpro) tablets
Indication(s)
metastatic NSCLC
Strength
45 mg
NDC code
00069-2299-30
Manufacturer
Pfizer
WAC per unit
$434.00
AWP per unit
$520.80
Generic (brand) name
lorlatinib (Lorbrena) tablets
Indication(s)
NSCLC
Strength
25 mg
NDC code
00069-0227-01
Manufacturer
Pfizer
WAC per unit
$187.32
AWP per unit
$224.78
Generic (brand) name
lorlatinib (Lorbrena) tablets
Indication(s)
NSCLC
Strength
100 mg
NDC code
00069-0231-01
Manufacturer
Pfizer
WAC per unit
$561.95
AWP per unit
$674.34
Generic (brand) name
selpercatinib (Retevmo) capsules
Indication(s)
metastatic NSCLC
Strength
40 mg
NDC code
00002-3977-60
Manufacturer
Eli Lilly
WAC per unit
$114.44
AWP per unit
$137.33
Generic (brand) name
selpercatinib (Retevmo) capsules
Indication(s)
metastatic NSCLC
Strength
80 mg
NDC code
00002-2980-26 (120 capsules)
00002-2980-60 (60 capsules)
Manufacturer
Eli Lilly
WAC per unit
$171.67
AWP per unit
$206.00

Gynecologic Malignancies

Generic (brand) name
lenvatinib (Lenvima) capsules
Indication(s)
advanced endometrial carcinoma
Strength
4 mg
NDC code
62856-704-05 (5 per package)
62856-704-30 (30 per package)
Manufacturer
Eisai
WAC per unit
$634.03
AWP per unit
$760.34
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
8 mg/day
(4 mg × 2)
NDC code
62856-708-05 (10 per package)
62856-708-30 (60 per package)
Manufacturer
Eisai
WAC per unit
$317.02
AWP per unit
$380.42
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
10 mg/day
(10 mg × 1)
NDC code
62856-710-05 (5 per package)
62856-710-30 (30 per package)
Manufacturer
Eisai
WAC per unit
$634.03
AWP per unit
$760.84
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
12 mg/day
(4 mg × 3)
NDC code
62856-712-05 (15 per package)
62856-712-30 (90 per package)
Manufacturer
Eisai
WAC per unit
$211.34
AWP per unit
$253.61
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
14 mg/day
14 mg/day (10 mg × 1 and 4 mg × 1)
NDC code
62856-714-05 (10 per package)
62856-714-30 (60 per package)
Manufacturer
Eisai
WAC per unit
$317.02
AWP per unit
$380.42
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
18 mg/day
(10 mg × 1 and 4 mg × 2)
NDC code
62856-718-05 (15 per package)
62856-718-30 (90 per package)
Manufacturer
Eisai
WAC per unit
$211.34
AWP per unit
$253.61
Generic (brand) name
lenvatinib (Lenvima) daily dose
Indication(s)
advanced endometrial carcinoma
Strength
20 mg/day
(10 mg × 2)
NDC code
62856-720-05 (10 per package)
62856-720-30 (60 per package)
Manufacturer
Eisai
WAC per unit
$317.02
AWP per unit
$380.42
Generic (brand) name
lenvatinib (Lenvima) capsules
Indication(s)
advanced endometrial carcinoma
Strength
24 mg/day
(10 mg × 2 and 4 mg × 1)
NDC code
62856-724-05 (15 per package)
62856-724-30 (90 per package)
Manufacturer
Eisai
WAC per unit
$211.34
AWP per unit
$253.61
Generic (brand) name
rucaparib (Rubraca) tablets
Indication(s)
epithelial ovarian, fallopian tube, or primary peritoneal cancer
Strength
200 mg
NDC code
69660-201-91
Manufacturer
Clovis
WAC per unit
$139.18
AWP per unit
$167.02
Generic (brand) name
rucaparib (Rubraca) tablets
Indication(s)
epithelial ovarian, fallopian tube, or primary peritoneal cancer
Strength
250 mg
NDC code
69660-202-91
Manufacturer
Clovis
WAC per unit
$139.18
AWP per unit
$167.02
Generic (brand) name
rucaparib (Rubraca) tablets
Indication(s)
epithelial ovarian, fallopian tube, or primary peritoneal cancer
Strength
300 mg
NDC code
69660-203-91
Manufacturer
Clovis
WAC per unit
$139.18
AWP per unit
$167.02

Hematologic Malignancies

Generic (brand) name
duvelisib (Copiktra) capsules
Indication(s)
relapsed or refractory CLL; relapsed or refractory FL; relapsed or refractory SLL
Strength
15 mg
NDC code
71779-115-02
Manufacturer
Verastem
WAC per unit
$221.25
AWP per unit
$265.50
Generic (brand) name
duvelisib (Copiktra) capsules
Indication(s)
relapsed or refractory CLL; relapsed or refractory FL; relapsed or refractory SLL
Strength
25 mg
NDC code
71779-125-02
Manufacturer
Verastem
WAC per unit
$221.25
AWP per unit
$265.50
Generic (brand) name
glasdegib (Daurismo) tablets
Indication(s)
newly diagnosed AML
Strength
25 mg
NDC code
00069-0298-60
Manufacturer
Pfizer
WAC per unit
$296.19
AWP per unit
$355.43
Generic (brand) name
glasdegib (Daurismo) tablets
Indication(s)
newly diagnosed AML
Strength
100 mg
NDC code
00069-1531-30
Manufacturer
Pfizer
WAC per unit
$592.39
AWP per unit
$710.85
Generic (brand) name
gilteritinib (Xospata) tablets
Indication(s)
relapsed or refractory AML
Strength
40 mg
NDC code
00469-1425-90
Manufacturer
Astellas
WAC per unit
$262.50
AWP per unit
$315.00
Generic (brand) name
ibrutinib (Imbruvica) tablets
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
140 mg
NDC code
57962-014-28 (28 per package)
Manufacturer
Pharmacyclics
WAC per unit
$463.08
AWP per unit
$555.69
Generic (brand) name
ibrutinib (Imbruvica) capsules
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
70 mg
NDC code
57962-070-28 (28 per package)
Manufacturer
Pharmacyclics
WAC per unit
$463.08
AWP per unit
$555.69
Generic (brand) name
ibrutinib (Imbruvica) capsules
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
140 mg
NDC code
57962-140-09 (90 per package)
Manufacturer
Pharmacyclics
WAC per unit
$154.36
AWP per unit
$185.23
Generic (brand) name
ibrutinib (Imbruvica) capsules
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
140 mg
NDC code
57962-140-12 (120 per package)
Manufacturer
Pharmacyclics
WAC per unit
$154.36
AWP per unit
$185.23
Generic (brand) name
ibrutinib (Imbruvica) tablets
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
280 mg
NDC code
57962-280-28 (28 per package)
Manufacturer
Pharmacyclics
WAC per unit
$463.08
AWP per unit
$555.69
Generic (brand) name
ibrutinib (Imbruvica) tablets
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
420 mg
NDC code
57962-420-28 (28 per package)
Manufacturer
Pharmacyclics
WAC per unit
$463.08
AWP per unit
$555.69
Generic (brand) name
ibrutinib (Imbruvica) tablets
Indication(s)
CLL; MCL; MZL; SLL; WM
Strength
560 mg
NDC code
57962-560-28 (28 per package)
Manufacturer
Pharmacyclics
WAC per unit
$463.08
AWP per unit
$555.69
Generic (brand) name
ivosidenib (Tibsovo) tablets
Indication(s)
AML
Strength
250 mg
NDC code
71334-100-01
Manufacturer
Agios
WAC per unit
$457.01
AWP per unit
$548.42
Generic (brand) name
pomalidomide (Pomalyst) capsules
Indication(s)
MM
Strength
1 mg
NDC code
59572-501-00 (100 per package)
59572-501-21 (21 per package)
Manufacturer
Celgene
WAC per unit
$868.53
AWP per unit
$1042.23
Generic (brand) name
pomalidomide (Pomalyst) capsules
Indication(s)
MM
Strength
2 mg
NDC code
59572-502-00 (100 per package)
59572-502-21 (21 per package)
Manufacturer
Celgene
WAC per unit
$868.53
AWP per unit
$1042.23
Generic (brand) name
pomalidomide (Pomalyst) capsules
Indication(s)
MM
Strength
3 mg
NDC code
59572-503-00 (100 per package)
59572-503-21 (21 per package)
Manufacturer
Celgene
WAC per unit
$868.53
AWP per unit
$1042.23
Generic (brand) name
pomalidomide (Pomalyst) capsules
Indication(s)
MM
Strength
4 mg
NDC code
59572-503-00 (100 per package)
59572-503-21 (21 per package)
Manufacturer
Celgene
WAC per unit
$868.53
AWP per unit
$1042.23
AML indicates acute myeloid leukemia; AWP, average wholesale price; CLL, chronic lymphocytic leukemia; FL, follicular lymphoma; MBC, metastatic breast cancer; MCL, mantle-cell lymphoma; MM, multiple myeloma; MZL, marginal zone lymphoma; NDC, National Drug Code; NSCLC, non–small-cell lung cancer; SLL, small lymphocytic lymphoma; WAC, wholesale acquisition cost; WM, Waldenström’s macroglobulinemia.

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