CurrentFlorida BluePolicy N/A

Retacrit (epoetin alfa-epbx) supply disruption and temporary substitution guidance

Guidance for Florida Blue commercial, Florida Blue Medicare Advantage, Truli for Health members (and BlueCard coordination) on substituting Procrit or Epogen when Retacrit (Q5105/Q5106) is out of stock; covers prior authorization handling and claim acceptance during the shortage.

Policy Summary

PayerFlorida Blue

PolicyRetacrit (epoetin alfa-epbx) supply disruption and temporary substitution guidance

Policy CodePolicy N/A

Change TypeAdded temporary substitution guidance

Effective Date

Next Review Date

Key ActionDo not request new authorizations for Procrit or Epogen when patients have existing active Retacrit authorizations; substituted claims (J0886/J0885) will be accepted during the out-of-stock period.

SourceLink

POLICY UPDATE CHANGES

Temporary substitution guidance allowing Procrit (J0886/J0885) or Epogen to be used when Retacrit is unavailable without requesting new authorizations for members with existing Retacrit authorizations.

J0885, J0886, Q5105, Q5106CPT/HCPCS codes referenced

Oct 2022Expected supply recovery timeframe

BlueCardMembers from other BCBS plans

Temporary substitution and claims acceptance

Temporary substitution for active Retacrit authorizations

Substitution to Procrit or Epogen is acceptable during the Retacrit supply disruption when ALL of the following apply:

ALL of the following

Patient has an active authorization for Retacrit (epoetin alfa-epbx) obtained through Magellan Rx Management, Florida Blue, or Truli for Health
Retacrit (Q5105 for ESRD on dialysis or Q5106 for non-ESRD use) is unavailable due to supply disruption
Provider substitutes Procrit or Epogen for the duration of the out-of-stock timeframe

Claims acceptance during out-of-stock timeframe

Claims for substituted products will be accepted when ALL of the following are true:

Policy Summary

PayerFlorida Blue

PolicyRetacrit (epoetin alfa-epbx) supply disruption and temporary substitution guidance

Policy CodePolicy N/A

Change TypeAdded temporary substitution guidance

Effective Date

Next Review Date

SourceLink

On This Page

Authorization, billing and documentation guidance

Prior Authorization

Use existing Retacrit authorizations for substitution

Do not request new authorizations for Procrit or Epogen when patients have existing active Retacrit authorizations (Q5105 for ESRD on dialysis, Q5106 for non-ESRD use) obtained through Magellan Rx Management, Florida Blue, or Truli for Health. For patients with active Retacrit authorizations, claims submitted for Procrit or Epogen (J0886/J0885) during the Retacrit out-of-stock timeframe will be accepted.

Q5105
Q5106
J0886
J0885

Prior Authorization

BlueCard member coordination

For BlueCard members, coordinate with the member's Blue Cross and Blue Shield home plan to determine whether a new authorization will be required for the substituted product.

Documentation Required

Reconversion when supply recovers

When Retacrit supply recovers, patients who were temporarily switched to Procrit or Epogen should be converted back to Retacrit (authorized under Q5105 or Q5106).

Q5105
Q5106

Supply disruption and substitution context

Pfizer has announced a supply disruption of Retacrit (epoetin alfa-epbx) caused by COVID-related manufacturing impacts. The manufacturer expects supply and out-of-stock issues during 2022, with anticipated supply recovery around October 2022, subject to change. [[0]]

During the shortage, providers should temporarily substitute other epoetin alfa products — specifically Procrit or Epogen — when Retacrit is unavailable. For members who already have active authorizations for Retacrit (authorization codes Q5105 for ESRD on dialysis and Q5106 for non-ESRD use) obtained through Magellan Rx Management, Florida Blue, or Truli for Health, there is no need to request new authorizations to use Procrit or Epogen. Claims for substituted products (J0886 for ESRD on dialysis; J0885 for non-ESRD use) submitted during the out-of-stock period will be accepted, and patients should be converted back to Retacrit when supply recovers. [[1]]

For BlueCard members (those covered by another Blue Cross and Blue Shield plan), providers must coordinate with the member’s home plan to determine whether a new authorization is required for the substituted product. Administrative handling described here applies to Florida Blue commercial, Florida Blue Medicare Advantage, and Truli for Health members as noted. [[1]]

Policy updates

2022added

Pfizer announced an expected 2022 supply disruption of Retacrit (epoetin alfa-epbx) due to COVID-related manufacturing impacts, with anticipated supply recovery around October 2022; temporary substitution guidance was created to allow use of Procrit or Epogen when Retacrit is unavailable.

2022-10 (anticipated)addedLatest

Guidance specifies that members with active Retacrit authorizations (Q5105 for ESRD on dialysis; Q5106 for non-ESRD use) through Magellan Rx Management, Florida Blue, Truli for Health, or Florida Blue Medicare Advantage may be temporarily switched to Procrit (J0886/J0885) without requesting new authorizations, and claims for the substituted products will be accepted during out-of-stock timeframes.

OpenPayer

Retacrit (epoetin alfa-epbx) supply disruption and temporary substitution guidance

Temporary substitution and claims acceptance

Relevant HCPCS / Authorization Codes

Authorization, billing and documentation guidance

Supply disruption and substitution context

Defined terms

Policy updates

Q5105	Retacrit (epoetin alfa-epbx) - authorization code referenced for ESRD on dialysis
Q5106	Retacrit (epoetin alfa-epbx) - authorization code referenced for non-ESRD use

J0886	Epoetin alfa, for ESRD on dialysis — Procrit/Epogen (code referenced for ESRD substitution)
J0885	Epoetin alfa, non-ESRD use — Procrit/Epogen (code referenced for non-ESRD substitution)