Effective Oct. 1, 2021, TerSera Therapeutics LLC., voluntarily withdrew from participation in the Medicaid Drug Rebate Program. As a result, New York State Medicaid fee-for-service (NYS FFS) and UnitedHealthcare Community Plan no longer cover most drugs manufactured by TerSera Therapeutics, LLC.
What this means for you
As of April 14, 2022, you’ll need to follow the "by report" billing process for ZOLADEX®, a drug manufactured by TerSera.
“By report” billing is used for a service, procedure or drug that is rarely provided, unusual or may require a special report to determine medical appropriateness, as indicated by the “BR” in the fee schedule. Information should include:
Additional details may include:
Appropriate documentation (e.g., procedure descriptions, itemized invoices, etc.) should accompany all claims.
Please note that NYS FFS will review all claims for ZOLADEX.