EFFECTIVE APRIL 1, 2024

New G Code: G0138

Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga 

G codes are national codes assigned by CMS to identify national healthcare procedures and services that may not have assigned CPT^®.¹ Not all payers are required to adopt this code.

POMBILITI (cipaglucosidase alfa-atga) for injection, for intravenous use, a bis-M6P enriched enzyme, in combination with OPFOLDA (miglustat) 65 mg capsules for oral use, an oral enzyme stabilizer, is the first and only 2-component therapy in late-onset Pompe disease and is designed to maximize enzyme activity.

POMBILITI™ (cipaglucosidase alfa-atga) in combination with OPFOLDA™ (miglustat) is indicated for the treatment of adult patients with late-onset Pompe disease (lysosomal acid alpha-glucosidase [GAA] deficiency) weighing ≥40 kg and who are not improving on their current enzyme replacement therapy (ERT).

Please see Important Safety Information at the end of this email.

This communication is intended to share information about this two-component treatment which comprises an infused and an oral drug. Because the two drugs are sold separately yet are required to be used in combination, this may require a review of your coverage or reimbursement policies for oral drugs under the medical benefit to ensure appropriate access and reimbursement for this therapy.

HCPCS Code Information

HCPCS, Healthcare Common Procedure Coding System

Per The Centers for Medicare & Medicaid Services: "To facilitate beneficiary access treatment of late-onset Pompe disease with miglustat in combination with cipaglucosidae alfa-atga, we are creating a new code, G0138, describing the service of administration of cipaglucosidase alfa-atga (Pombiliti), which includes the intravenous administration of cipaglucosidase alfa-atga, the provider or supplier’s acquisition cost of miglustat, clinical supervision, and oral administration of miglustat."¹

POMBILITI (cipaglucosidase alfa-atga) Vial Information:

DESCRIPTION: For intravenous use, supplied as a single-dose vial for reconstitution containing 105 mg of cipaglucosidase alfa-atga as a lyophilized powder.

**J1203 HCPCS Unit = 5 mg

OPFOLDA (miglustat) 65 mg Capsules Information

DESCRIPTION: Supplied as 65 mg gelatin capsules

***J1202 HCPCS Unit = 1 capsule (65 mg)

*NDC=National Drug Code. NDC has been “zero-filled” to ensure creation of an 11-digit code that meets Health Insurance Portability and Accountability Act (HIPAA) standards. The zero-fill location is indicated in bold.

WAC Prices are current as of March 15, 2024

POMBILITI^TM (cipaglucosidase alfa-atga) and OPFOLDA^TM (miglustat)

IMPORTANT SAFETY INFORMATION

WARNING: SEVERE HYPERSENSITIVITY REACTIONS, INFUSION-ASSOCIATED REACTIONS, and RISK OF ACUTE CARDIORESPIRATORY FAILURE IN SUSCEPTIBLE PATIENTS

HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS

Patients treated with POMBILITI have experienced life-threatening hypersensitivity reactions, including anaphylaxis. Appropriate medical support measures, including cardiopulmonary resuscitation equipment, should be readily available during POMBILITI administration. If a severe hypersensitivity reaction (e.g., anaphylaxis) occurs, POMBILITI should be discontinued immediately, and appropriate medical treatment should be initiated. In patients with severe hypersensitivity reaction, desensitization measures to POMBILITI may be considered. The risks and benefits of readministering POMBILITI following severe hypersensitivity reaction should be considered. If mild or moderate hypersensitivity reaction occurs, the infusion rate may be slowed or temporarily stopped. Prior to POMBILITI administration, consider pretreating with antihistamines, antipyretics, and/or corticosteroids.

INFUSION-ASSOCIATED REACTIONS (IARs)

Patients treated with POMBILITI have experienced severe IARs. If severe IARs occur, immediately discontinue the POMBILITI infusion, initiate appropriate medical treatment, and assess the benefits and risks of readministering POMBILITI following severe IARs. If mild or moderate IARs occur regardless of pretreatment, decreasing the infusion rate or temporarily stopping the infusion may ameliorate the symptoms. IARs may still occur in patients after receiving pretreatment.

Patients with an acute underlying illness at the time of POMBILITI infusion may be at greater risk for IARs. Patients with advanced Pompe disease may have compromised cardiac and respiratory function, which may predispose them to a higher risk of severe complications from IARs.

RISK OF ACUTE CARDIORESPIRATORY FAILURE IN SUSCEPTIBLE PATIENTS



Patients susceptible to fluid volume overload, or those with acute underlying respiratory illness or compromised cardiac or respiratory function for whom fluid restriction is indicated may be at risk of serious exacerbation of their cardiac or respiratory status during POMBILITI infusion. More frequent monitoring of vitals should be performed during POMBILITI infusion in such patients.

CONTRAINDICATION

POMBILITI in combination with OPFOLDA is contraindicated in pregnancy.

EMBRYO-FETAL TOXICITY

Based on findings from animal reproduction studies, POMBILITI in combination with OPFOLDA may cause embryo-fetal harm when administered to a pregnant female and is contraindicated during pregnancy. Verify the pregnancy status in females of reproductive potential prior to initiating treatment with POMBILITI in combination with OPFOLDA. Advise females of reproductive potential to use effective contraception during treatment with POMBILITI in combination with OPFOLDA and for at least 60 days after the last dose.

RISKS ASSOCIATED WITH POMBILITI AND OPFOLDA

POMBILITI and OPFOLDA must be administered in combination.

ADVERSE REACTIONS

The most common adverse reactions (≥5%) reported in the pooled safety population of patients treated with POMBILITI in combination with OPFOLDA in the 3 clinical trials were headache, diarrhea, fatigue, nausea, abdominal pain, and pyrexia.

To report SUSPECTED ADVERSE REACTIONS, contact Amicus Therapeutics at 1-877-4AMICUS or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

LACTATION

Advise females that breastfeeding is not recommended while on treatment with POMBILITI in combination with OPFOLDA.

INDICATION

POMBILITI in combination with OPFOLDA is indicated for the treatment of adult patients with late-onset Pompe disease (lysosomal acid alpha-glucosidase [GAA] deficiency) weighing ≥40 kg and who are not improving on their current enzyme replacement therapy (ERT).

Please see full Prescribing Information, including BOXED WARNING, for POMBILITI and full Prescribing Information for OPFOLDA, also available at PombilitiOpfoldaHCP.com.

References:

1. “Fourth Quarter, 2023 HCPCS Coding Cycle.” CMS.gov. Accessed February 8, 2024. https://www.cms.gov/files/document/2023-hcpcs-application-summary-quarter-3-2023-drugs-and-biologicals-updated-11/16/2023.pdf, p. 6.