According to a news release, the J-code for SYFOVRE will become effective on October 1, 2023.
Apellis Pharmaceuticals, Inc. today announced that the US Centers for Medicare and Medicaid Services (CMS) has assigned a permanent and product-specific J-code (J2781) for pegcetacoplan injection (SYFOVRE), the first-ever treatment for geographic atrophy (GA) secondary to age-related macular degeneration.
According to a news release, the J-code for SYFOVRE will become effective on October 1, 2023. GA is a leading cause of blindness that impacts more than 5 million people globally including 1 million people in the United States.1,2
Adam Townsend, chief commercial officer for Apellis, noted that prior to pegcetacoplan injection, patients had nothing to slow the progression of this disease.
“The permanent J-code is a significant milestone that will help ensure accurate and efficient reimbursement of SYFOVRE in all treatment settings, building on our goal of bringing this important treatment to GA patients in need,” Townsend said in the news release.
J-codes are permanent reimbursement codes used by government payers and commercial insurers to facilitate billing of Medicare Part B treatments, which must be administered by a healthcare professional. J-codes simplify and streamline the billing and reimbursement processes, allowing for efficient claims processing.
The FDA in February announced its approval of the pegcetacoplan injection for the treatment of GA. The approval was based on the results of the 24-month phase 3 data submitted in its New Drug Application in November 2022.
According to the company, pegcetacoplan is designed to regulate excessive activation of the complement cascade, part of the body’s immune system, which can lead to the onset and progression of many serious diseases.
1 Rudnicka AR, Jarrar Z, Wormald R, et al. Age and gender variations in age-related macular degeneration prevalence in populations of European ancestry: a meta analysis. Ophthalmology 2012;119:571–580.
2 Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health 2014;2:e106–116.