Earnings Release • Nov 5, 2019
Earnings Release
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Photocure: Cysview® reimbursement further improved from January 2020
CMS final rule expands complexity adjustment for Hospital Outpatient from two to
three procedure codes and increases the reimbursement due to the complexity
adjustment for these procedures by $92 compared to 2019.
Oslo, Norway, November 6,[ ]2019 Photocure ASA., (OSE: PHO), The United States
Centers for Medicare and Medicaid Services (CMS) has released its Final Rule
maintaining the reimbursement code (A Code) for Cysview when used in hospital
outpatient and other sites of care and improved the complexity adjustment
codes. This will result in additional reimbursement of $92 for certain Blue
Light Cystoscopy (BLCT) procedures when used in hospital outpatient departments
effective January 1st, 2020.
Link for access to the Rule: https://s3.amazonaws.com/public
-inspection.federalregister.gov/2019-24138.pdf
In addition, CMS confirmed that the complexity adjustment will be available for
procedures billed under 52204, 52214, and 52224 (52214 being new for 2020), if
also billed with the A9589 code for the drug and the C9738 code for the
complexity adjustment. The increased reimbursement due to the complexity
adjustment will be $1,247 ($1,187 in 2019). This will result in an increase in
reimbursement of payment for Blue Light Cystoscopy procedures when used in
hospital outpatient department under the complexity adjustment conditions
applicable to the three procedures in 2020 from standard white light at $1,771
(for APC 5373) to $3,018 with Cysview (for APC 5374).
"The effectiveness and benefits of using Blue Light Cystoscopy (BLCT) with
Cysview for improved detection and management of bladder cancer are widely
recognized. We are pleased that CMS has implemented an additional complexity
adjustment code for Cysview and improved reimbursement compared to 2019. We,
along with many stakeholders in the Bladder Cancer Community, (including the
Large Urology Group Practice Association (LUGPA), American Urological
Association (AUA), the patient advocacy group Bladder Cancer Advocacy Network
(BCAN), and individual Urologists and Patients), will continue to work to
further increase access for all patients regardless of the site of care to this
leading-edge technology for the management of bladder cancer," commented Dan
Schneider, President and Chief Executive Officer of Photocure ASA.
About Bladder Cancer
Bladder cancer ranks as the ninth most common cancer worldwide with 430 000 new
cases and more than 165 000 deaths annually. Approx. 75% of all bladder cancer
cases occur in men[1]. It has a high recurrence rate with an average of 61% in
year one and 78% over five years[2]. Bladder cancer has the highest lifetime
treatment costs per patient of all cancers[3].
Bladder cancer is a costly, potentially progressive disease for which patients
have to undergo multiple cystoscopies due to the high risk of recurrence. There
is an urgent need to improve both the diagnosis and the management of bladder
cancer for the benefit of patients and healthcare systems alike.
Bladder cancer is classified into two types, non-muscle invasive bladder cancer
(NMIBC) and muscle-invasive bladder cancer (MIBC), depending on the depth of
invasion in the bladder wall. NMIBC remains in the inner layer of cells lining
the bladder. These cancers are the most common (75%) of all BC cases and include
the subtypes Ta, carcinoma in situ (CIS) and T1 lesions. MIBC is when the cancer
has grown into deeper layers of the bladder wall. These cancers, including
subtypes T2, T3 and T4, are more likely to spread and are harder to treat[4].
About Hexvix[®]/Cysview[®] (hexaminolevulinate HCl)
Hexvix[®]/Cysview[®] is a drug that is selectively taken up by tumor cells in
the bladder making them glow bright pink during Blue Light Cystoscopy (BLC[TM]).
BLCT with Hexvix[®] /Cysview[®] improves the detection of tumors and leads to
more complete resection, fewer residual tumors and better management decisions.
Cysview[®] is the tradename in the US and Canada, Hexvix[®] is the tradename in
all other markets. Photocure is commercializing Cysview[®] / Hexvix[®] directly
in the US and the Nordic region and has strategic partnerships for the
commercialization of Hexvix[® ]/ Cysview[®] in Europe, Canada, Australia and New
Zealand. Please refer to https://bit.ly/2wzqSQQ for further information on our
commercial partners.
All trademarks mentioned in this release are protected by law and are registered
trademarks of Photocure ASA
This press release may contain product details and information which are not
valid, or a product is not accessible, in your country. Please be aware that
Photocure does not take any responsibility for accessing such information which
may not comply with any legal process, regulation, registration or usage in the
country of your origin.
References
1. Globocan. Incidence/mortality by population. Available
at: http://globocan.iarc.fr/Default.aspx
2. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Compérat E, et al.
EAU Guidelines on
non-muscle-invasive bladder cancer (Ta, T1 and CIS). Eur Urol. 2016
Guidelines Edition:1-40.
3. Sievert KD et al. World J Urol 2009;27:295-300
4. Bladder Cancer. American Cancer Society.
https://www.cancer.org/cancer/bladder-cancer.html
For more information, please contact:
Dan Schneider
President and CEO
Photocure ASA
Tel: + 1-609 759-6515
Email: [email protected]
Erik Dahl
CFO
Photocure ASA
Tel: +4745055000
Email: [email protected]
About Photocure ASA
Photocure: The Bladder Cancer Company delivers transformative solutions to
improve the lives of bladder cancer patients. Our unique technology, which makes
cancer cells glow bright pink, has led to better health outcomes for patients
worldwide. Photocure is headquartered in Oslo, Norway, and listed on the Oslo
Stock Exchange (OSE: PHO). For more information, please visit us at
www.photocure.com, www.hexvix.com or www.cysview.com
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