Pharmacies dispensing adalimumab-aaty, sold by Celltrion USA under the brand names Yuflyma and Zymfentra, should carefully review claims to be sure that the quantity submitted matches the package size to minimize under- or over-reimbursement. The affected products' packaging now includes a tray for each syringe or pen supplied.
The product is still billed as "eaches" but now has two trays, so the quantity on the new packages is two. Before Nov. 1, some suppliers and dispensers will have the new package size (with trays) in inventory while the databases still show the old package size and vice versa.
Make sure the pharmacy team understands which package size is used in the pharmacy system drug file and the possibility of claim rejections due to mismatches against what the payer drug file is using. Also, ensure you have a plan in place to resolve the rejection.
