Makena® (hydroxyprogesterone caproate injection) may be purchased directly from a specialty distributor or wholesaler and stocked in the healthcare provider's office
|McKesson Plasma and Biologics
Patient benefits investigation and support programs connections, all in one place. To help support patient benefits investigations and prior authorizations for your patient, visit iAssist.com, select Makena, and click on Buy-and-Bill Benefits Investigation for support. This resource also helps you connect patients to support programs.
Personalized Patient Support. Healthcare Professional Resources. More Than Makena.Makena Care Connection® offers personalized support that helps verify insurance coverage and obtain prior authorizations (when applicable), addresses your patients’ financial concerns, and encourages adherence to therapy. Learn more
Below is billing and coding information that is required for Makena when completing the CMS 1500 claim form. Please note, code and claim information requirements may vary by insurer and benefit plan. Patient coverage and codes should be verified before purchasing and billing.
*National Drug Code (payer requirements regarding 10-digit and 11-digit NDC may vary).
†Current Procedural Terminology.
‡International Classification of Diseases–9th Revision–Clinical Modification.
§International Classification of Diseases–10th Revision–Clinical Modification.
||Healthcare Common Procedure Coding System.
Offices purchasing Makena may receive a volume discount from their specialty distributor.
Makena can be ordered through the following specialty distributors. Please call for specific ordering instructions.
Makena is also available via drop shipment through your preferred wholesaler. If you prefer to receive your order via drop shipment, please contact your wholesaler directly for more information.
Obtain the correct claim requirements in writing from the patient's insurer before submitting a claim for each weekly dose of Makena.
Under certain circumstances, for both the single-dose and multi-dose vials, Makena may be returned for credit when purchased through CuraScript, Inc., McKesson Plasma and Biologics, or TheraCom, or via drop shipment. The policy has certain limitations and applies to expired doses that are not billable.*
*Product that is returned without a completed and approved Returns Request Form will be destroyed without credit.
Yes. 340B-eligible hospitals and other eligible facilities can obtain Makena through CuraScript, Inc., McKesson Plasma and Biologics, or TheraCom.
Yes. Drop shipments from wholesalers are available. Drop shipment capabilities must be established between the wholesaler and the specialty distributor (CuraScript, Inc., McKesson Plasma and Biologics, or TheraCom). Payment terms are governed by the customer/wholesaler agreement, independent of the Makena specialty distributors.
Refer to the billing and coding procedures. When verifying a patient's insurance benefits, confirm the codes required by the payer, as the required codes may vary. Confirm patient benefits and the correct payer-specific codes for each patient to help prevent errors and ensure timely reimbursement.
Yes. If a patient cannot afford her out-of-pocket expense, she should contact Makena Care Connection (1-800-847-3418) directly to assess her eligibility. The patient should let Makena Care Connection know that she is receiving Makena and is in need of assistance (applies to copays, coinsurance, and deductibles).
We are committed to helping ensure cost is not a barrier to acceptance of therapy. If the patient is uninsured, a Makena Prescription Form should be submitted to Makena Care Connection with the "Patient does not have insurance" box checked in Step 1. Makena Care Connection will determine if she is eligible for a free course of therapy.
If Makena® (hydroxyprogesterone caproate injection) is ordered and stocked in the office, contact the individual's payer/insurer and inquire about the patient's benefits. This coding worksheet will assist in verifying the correct billing codes.
To help support benefits investigations and prior authorizations for your patients, visit iAssist.com, select Makena, and click on Buy-and-Bill Benefits Investigation for support.
Makena (hydroxyprogesterone caproate injection) is a progestin indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth. The effectiveness of Makena is based on improvement in the proportion of women who delivered <37 weeks of gestation. There are no controlled trials demonstrating a direct clinical benefit, such as improvement in neonatal mortality and morbidity.
Limitation of use: While there are many risk factors for preterm birth, safety and efficacy of Makena has been demonstrated only in women with a prior spontaneous singleton preterm birth. It is not intended for use in women with multiple gestations or other risk factors for preterm birth.
Please see full Prescribing Information for Makena.
References: 1. American Medical Association. Current Procedural Terminology 2014: Professional Edition. Chicago, IL: American Medical Association; 2013. 2. Buck CJ. 2014 ICD-9-CM Volumes 1, 2 & 3: For Hospitals. St. Louis, MO: Saunders Elsevier; 2014. 3. American Medical Association. ICD-10-CM The Complete Official Draft Code Set. Chicago, IL: American Medical Association; 2014. 4. PMIC. HCPCS: Health Care Procedure Coding System, National Level II Medicare Codes 2014. Los Angeles, CA: Practice Management Information Corporation; 2013.