Rhophylac® Ordering and Reimbursement

Rhophylac^® is available by prescription only. It is supplied in packages containing either 1 prefilled syringe or 10 prefilled syringes.

<b>NDC Chart-</b> Rhophylac<sup>®</sup> is available by prescription only.<b> Reimbursement Chart-</b> Reimbursement Codes for Rhophylac<sup>®</sup>

^*A full dose of Rhophylac^® is 1500 IU; therefore, total billable units entered on the billing form should be 15.

Following is a list of authorized distributors of Rhophylac^®:

ABO Pharmaceuticals
ASD Specialty
Anda
Atlantic Biologics
Blood Diagnostics
Cardinal SPD
CT International
FFF Enterprises
Health Coalition

Henry Schein
Lifeline Pharmaceuticals LLC
NHS/Genesis
Novis Pharmaceuticals
Prodigy Health
Seacoast Medical
Smith Medical Partners
UBS/BCA/Biocare
US Oncology

To order, please call CSL Behring at 1-800-655-3396. For technical and medical questions about Rhophylac^®, please call Medical Affairs at 1-800-504-5434.

For your convenience, reimbursement codes for Rhophylac^® are shown below. (Note: All codes should be verified between the provider and the payer.)

Please visit the CSL Behring Reimbursement Resource Center for information on insurance matters, coverage trends, patient assistance, and more.

To speak with a representative, call the Reimbursement Answerline at 1-800-676-4266 Monday through Friday from 8 a.m. to 5 p.m. ET. Find out about:

Claim processing reviews
Appeals
Insurance investigations into product coverage
Prior approvals for therapies authorization

*An intravenous push is defined as:a) an injection in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient,or b) an infusion of 15 minutes or less.

All codes listed are for informational purposes only. The CPT codes provided are based on AMA guidelines. The treating physician is solely responsible for diagnosis coding. The billing party is solely responsible for the CPT coding. Please direct any questions regarding coding to the payer being billed.

Important Safety Information

Rhophylac^® is indicated for suppression of rhesus (Rh) isoimmunization in:

Pregnancy and obstetric conditions in non-sensitized, Rho(D)-negative women with an Rh-incompatible pregnancy, including routine antepartum and postpartum Rh prophylaxis and Rh prophylaxis in cases of obstetric complications, invasive procedures during pregnancy, or obstetric manipulative procedures.
Incompatible transfusions in Rho(D)-negative individuals transfused with blood components containing Rho(D)-positive red blood cells.

For suppression of Rh isommunization, Rhophylac^® can be administered IM or IV.

Rhophylac^® is contraindicated in individuals with known anaphylactic or severe systemic reaction to human immune globulin products.

Allergic or hypersensitivity reactions may occur with Rhophylac^®; early signs of hypersensitivity include generalized urticaria, chest tightness, wheezing, hypotension, and anaphylaxis. Individuals with selective IgA deficiency can develop antibodies to IgA and may develop severe hypersensitivity and anaphylactic reactions. For these individuals, weigh the expected benefits of treatment against the potential risks.

Rhophylac^® is derived from human plasma. As with all plasma-derived products, the risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent, cannot be completely eliminated.

For postpartum use following an Rh-incompatible pregnancy, Rhophylac^® should not be given to the newborn infant.

The most common adverse reactions in the suppression of Rh isoimmunization with Rhophylac^® are nausea, dizziness, headache, injection-site pain, and malaise.

Please see full prescribing information.