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Table 1. CMS Reimbursement and Oral Drug Prices —
Regimens and Prices for Treatment of Stage IV
NSCLC with Driver Alterations
Agent,
Route,
Treatment
Setting
HCPCS
CODE Dose Schedule
2020 Medicare
Drug Prices
(part D)
Price (USD) for
monthly dose Schedule
Atezolizumab
Injection
a
J9022 10 mg Every 3
weeks
77.759 1200 mg
(flat dose)
every 3 weeks
(in combination
with
bevacizumab and
chemotherapy
doublet)
Bevacizumab
Injection
a
J9035 10 mg Every 3
weeks
81.18 15 mg/kg every
3 weeks
Pemetrexed
a
Injection
J9305 10 mg 68.12
500mg /m
2
every 3 weeks
Ramucirumab
J9308
5 mg/kg
× 2
Every 2
weeks
60.71 10 mg/kg every
2 weeks
a
According to driver alteration guideline (Hanna JCO 2020).
(cont'd)
