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Generic Name Brentuximab vedotin
Brand Name Adcetris®
Payment Category Medicare Part B
Year Introduced 2011
Type of Drug CD30-directed antibody-drug conjugate
Manufacturer Seattle Genetics
Medical Affairs Questions (date verified) 855.473.2436
Coverage & Reimbursement Questions 855.473.2436
HCPCS J9042
Billing Unit 1 mg
Medicare Payment Limit (Effective January 1, 2021) $182.08

FDA-Approved Indication(s)

  • Indicated for treatment of adult patients with 1) Previously untreated Stage III or Stage IV classical Hodgkin Lymphoma (cHL) in combination with doxorubicin, vinblastine, and dacarbazine, 2) cHL at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (AHSCT) consolidation, 3) cHL after failure of AHSCT or failure of at least two prior multi-agent chemotherapy regimens in patients who are not AHSCT candidates, 4) Previously untreated systemic anaplastic large cell or other CD30-expressing peripheral T-cell lymphomas (PTCL), including angioimmunoblastic T-cell lymphoma and PTCL not otherwise classified, in combination w cyclophosphamide, doxorubicin, and prednisone, and 5) Systemic anaplastic large cell lymphoma after failure of at least one prior multi-agent chemotherapy regimen. (11/19/18)

Approved Indication(s) with Orphan Drug Status 1) Treatment of Hodgkin's lymphoma. 2) Treatment of anaplastic large cell lymphoma. 3) Treatment of mycosis fungoides. 4) Treatment of patients with peripheral T-cell lymphoma, NOS. 5) Treatment of primary cutaneous CD30-positive T-cell lymphoproliferative disorders.
ICD-10 Code(s) for Labeled Indication(s) Hodgkin lymphoma [C81.xx]; Anaplastic large cell lymphoma, ALK-positive [C84.6x] or ALK-negative [C84.7x]; Mycosis fungoides [C84.0]
Name Strength Form Package Labeler NDC

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