Degarelix® for subcutaneous injection, a GnRH receptor antagonist, is indicated for the treatment of advanced prostate cancer. It binds reversibly to the pituitary GnRH receptors, thus reducing the release of ganadotropins and consequently testosterone. Palmetto GBA will reimburse Degarelix claims for patients resistant to LHRH analogues and as first line therapy.

To submit claims for Degarelix services, submit the following items:

• HCPCS code J3490 – unclassified drugs
• Enter the following information in the comment/narrative note field:
  • NDC number
  • Degarelix
  • Dosage
• Until Palmetto GBA receives enough claims to determine a price, providers must submit an invoice copy for this drug.

NOTE: If postpayment review reveals concurrent use of an LHRH and a Degarelix injection within the LHRH therapeutic time range, Degarelix services will be denied. An identified pattern of concurrent use will result in a Recovery Audit Contractor (RAC) referral.