The ADCETRIS® (brentuximab vedotin) Payer Map allows you to find payer policies based on your state and your patient's specific payer. Click here to access.
Frequently Asked Questions
The complexities of healthcare often leave many in a position of needing assistance with where to turn for answers and information. At Seattle Genetics it is our responsibility to provide options, resources and assistance for patients being treated with ADCETRIS® (brentuximab vedotin).
- How do I know if my patient's insurance covers ADCETRIS?
Navigating insurance plans, coverage and requirements can be time-consuming and confusing. SeaGen Secure® reimbursement counselors are trained to help you navigate your or your patient's coverage for ADCETRIS.
Option 1 – Complete the Benefits Investigation Request Form and fax it to SeaGen Secure at 855.557.2480.
Option 2 – Contact SeaGen Secure at 855.473.2436, option 1, M-F from 9 AM–8 PM ET. Be prepared with the patient's insurance information. Benefits investigation results will be faxed within 48 hours.
- How do I find ADCETRIS payer policies?
The easiest way to obtain an ADCETRIS policy is to utilize the ADCETRIS Payer Map located on the home page of this Web site.
Additionally, SeaGen Secure® keeps an updated database of ADCETRIS policies that includes Medicare LCDs, Medicaid and commercial policies.
Contact us at 855.473.2436, option 1, M-F from 9 AM–8 PM ET to inquire about a specific payer's policy or obtain a copy of a current policy.
- What HCPCS code(s) should be used to bill ADCETRIS?
See the coding table below for ADCETRIS coding information.
Clinic CPT/HCPCS Adcetris J9042 (Injection, brentuximab vedotin, 1 mg) Hospital Outpatient CPT/HCPCS Adcetris J9042 (Injection, brentuximab vedotin, 1 mg) - Will Medicare cover ADCETRIS?
Medicare covers FDA-approved therapies like ADCETRIS for medically necessary treatments when given incident to a physician's services. SeaGen Secure® can research your patient’s benefits. Please complete an enrollment form or call SeaGen Secure directly with your patient's insurance information.
- Will my patient's managed care organization or Medicaid cover ADCETRIS?
Managed care and Medicaid plans may provide coverage for ADCETRIS. It is very important to review your specific patient's coverage to determine exact coverage, coding and patient co-payment for ADCETRIS. SeaGen Secure® maintains a database of current managed care and Medicaid policies.
Should you receive reimbursement you believe is incorrect, you may contact SeaGen Secure for assistance.
- At what rate does Medicare reimburse ADCETRIS?
Medicare reimburses covered drugs and biologics under Part B based on average sales price (ASP).
Medicare reimburses 80% of this allowed amount. ASP is updated quarterly and available at www.cms.gov/asp.
Should you receive reimbursement you believe is incorrect, please notify SeaGen Secure® so we can assist with the denial or underpayment.
Do you have a reimbursement question for SeaGen Secure? Please see the ADCETRIS Payer Map.
- How does Medicare reimburse for drugs administered when part of the vial is discarded?
CMS encourages physicians to schedule patients in such a way that they can use drugs most efficiently. However, if a physician must discard the remainder of a vial or other package after administering it to a Medicare patient, the program covers the amount of the drug discarded along with the amount administered. This coverage applies only to single-use vials. Multi-use vials are not subject to payment for discarded amounts of drug.
Source: Medicare Claims Processing Manual, Chapter 17, section 40 - Discarded Drugs and Biologics.
Providers should document the amount of drug administered, the amount discarded and the reason it was discarded.
- Is there ADCETRIS claims assistance?
Yes. SeaGen Secure® can assist with denied or underpaid claims for ADCETRIS and/or its administration. Providers or patients should be prepared to fax copies of the claim(s), EOBs/Remittance Notices, Letters of Medical Necessity (LMNs) and/or letters used in appeal to 855.557.2480.
Reimbursement counselors will follow up with the payer to determine why the claim was underpaid or denied and what follow-up steps are needed for reimbursement. They will also begin the appeals process by providing a sample LMN and may refer you to Medical Information if needed.
- Is there co-insurance assistance for patients on ADCETRIS?
Yes. Currently Seattle Genetics offers a commercial Co-insurance Assistance Program. Eligibility is similar to the regular ADCETRIS Patient Assistance Program but patients must be diagnosed with a labeled indication and cannot reside in MA. Contact SeaGen Secure® for more details.
Additionally, there are multiple foundations with funds for cancer patients. SeaGen Secure can provide contact information for these foundations. Many offer online information and applications. See the table below for all current foundations.
Foundation Abbreviation CancerCare CC Chronic Disease Fund CDF HealthWell HW Leukemia & Lymphoma Society LLS National Organization of Rare Diseases NORD Patient Access Network Foundation PANF Patient Advocate Foundation PAF Patient Services Incorporated PSI Some foundations offer retroactive assistance for patients (subject to change)
- HealthWell will go back 60 days
- LLS will pay any co-payment accrued in the fiscal year (July 1-June 30)
- PANF will go back 90 days
- PAF will go back 1 year
NOTE: Additional details can be found on the Leukemia and Lymphoma Society Web site: http://www.lls.org/diseaseinformation.
- How Is ADCETRIS shipped?
After a patient is enrolled into the Patient Assistance Program, providers complete and submit an ADCETRIS Product Request Form (PRF). Please allow 2 business days for shipment after a completed PRF is received.
If you are a healthcare professional residing in Canada and have questions about SeaGen Secure®, please call 855.4SEAGEN (855.473.2436).