Campath Reimbursement
CamCare reimbursement consultants offer services to help providers and patients
with product-related reimbursement questions. CamCare reimbursement consultants
can be reached at the CamCare Support Line: 1-800-473-5832 (9
AM to 5 PM ET, Monday through Friday).
Services Overview
CamCare reimbursement consultants have experience across all payer types, including
Medicare. Consultants closely monitor policy changes, such as recent Medicare reform,
to provide accurate and timely information. Questions answered by the team are wide-ranging,
but typically can be classified into one of the following groups:
- Benefit Verification: identifies patient-specific product coverage
guidelines; can include identification of potential diagnosis restrictions and patient
cost-sharing details
- Coding Assistance and Billing Instruction: helps ensure that correct
codes (including CPT and HCPCS) and billing units are submitted to the payer*
- Claims Review: prior to claims submission, a team consultant will
review claim(s) for completeness and accuracy
- Claims Appeal Assistance: helps identify the reason(s) for denial
of claim(s) and collaborates with the provider to create a patient-specific and
payer-specific appeal strategy
- Prior Authorization Assistance: consultants can act as a liaison
between payer and provider to determine the prior authorization process and requirements;
can assist the provider in the creation of payer-requested information such as a
letter of medical necessity
- Patient Assistance: Bayer HealthCare Pharmaceuticals offers a program
that provides treatment to uninsured patients who meet program criteria
CamCare reimbursement consultants provide the highest level of reimbursement support
and patient assistance. Consultants closely monitor the reimbursement environments
for the latest changes in Medicare, Medicaid, and private payer reimbursement and
coverage policies. The result is a knowledgeable staff capable of answering calls,
processing patient assistance applications, and providing product-specific support
to the provider and patient communities.
WARNING: CYTOPENIAS, INFUSION REACTIONS, and INFECTIONS
Cytopenias: Serious, including fatal, pancytopenia/marrow hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia can occur in patients receiving Campath. Single doses of Campath greater than 30 mg or cumulative doses greater than 90 mg per week increase the incidence of pancytopenia.
Infusion Reactions: Campath administration can result in serious, including fatal, infusion reactions. Carefully monitor patients during infusions and withhold Campath for Grade 3 or 4 infusion reactions. Gradually escalate Campath to the recommended dose at the initiation of therapy and after interruption of therapy for 7 or more days.
Infections: Serious, including fatal, bacterial, viral, fungal, and protozoan infections can occur in patients receiving Campath. Administer prophylaxis against Pneumocystis jiroveci pneumonia (PCP) and herpes virus infections.
In clinical trials, the frequency of infusion reactions was highest in the first week of treatment. The following serious, including fatal, infusion reactions have been identified in post-marketing reports: syncope, pulmonary infiltrates, acute respiratory distress syndrome (ARDS), respiratory arrest, cardiac arrhythmias, myocardial infarction, acute cardiac insufficiency, cardiac arrest, angioedema, and anaphylactoid shock.
Prolonged myelosuppression have been reported in patients receiving Campath. Campath treatment results in severe and prolonged lymphopenia with a concomitant increased incidence of opportunistic infections. Assess CD4+ counts after treatment until recovery to ≥ 200 cells/µL. Obtain complete blood counts (CBC) at weekly intervals during Campath therapy and more frequently if worsening anemia, neutropenia, or thrombocytopenia occurs. Withhold Campath for severe cytopenias (except lymphopenia). Discontinue for autoimmune cytopenias or recurrent/persistent severe cytopenias (except lymphopenia).
Administer only irradiated blood products to avoid transfusion associated Graft versus Host Disease (TAGVHD), unless emergent circumstances dictate immediate transfusion.
Routinely monitor patients for CMV infection during Campath treatment and for at least 2 months following completion of treatment. Withhold Campath for serious infections and during antiviral treatment for CMV infection or confirmed CMV viremia. Initiate therapeutic ganciclovir (or equivalent) for CMV infection or confirmed CMV viremia.
Do not administer live viral vaccines to patients who have recently received Campath.
The most common adverse reactions (≥ 10%) were infusion reactions, cytopenias, cytomegalovirus (CMV) and other infections, nausea, emesis, diarrhea, and insomnia.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
For important risk and use information, please see full Prescribing Information (PDF).
