Medicare Claims Processing
The Medicare benefits are administered by insurance companies acting as contractors at a local jurisdiction level. Historically, Medicare contractors have been fiscal intermediaries (FIs), responsible for processing facility claims, and carriers, responsible for processing most outpatient provider claims. Medicare is in the process of transitioning FIs and carriers to Medicare Administrative Contractors (MACs). MACs will consolidate all claim processing responsibilities for facility and non-facility healthcare providers within a single contractor for a geographic region. This transition means that, as a healthcare provider, you may have experienced or may now be experiencing a change in the Medicare contractor that processes your Medicare claims. As a result, you may be working through process or coverage changes within your practice or institution.
The Medicare contractors responsible for developing coverage guidelines and processing claims for services vary by state and by the type of service that is provided. Medicare contractors may publish coverage parameters for Medicare-covered drugs and services in the form of a local coverage determination (LCD) or through other provider communications. It is important to confirm coverage guidelines with your local Medicare contractor to understand any established diagnosis, clinical, or dosing guidelines that may apply to the service being provided to the patient.
Astellas Reimbursement Services is also available to help you understand the changing Medicare contractor environment and the coverage guidelines that may be in place in your state. You can call 1-800-477-6472 for Medicare support from a reimbursement specialist who understands Medicare coverage and claims specific to your geographic location.
INDICATION AND DOSAGE
VESIcare tablets are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. The recommended dose of VESIcare is 5 mg once daily. If the 5-mg dose is well tolerated, the dose may be increased to 10 mg once daily.
IMPORTANT SAFETY INFORMATION
VESIcare is contraindicated in patients with urinary retention, gastric retention, uncontrolled narrow-angle glaucoma, and in patients with hypersensitivity to the product.
Angioedema of the face, lips, tongue and/or larynx have been reported with VESIcare. In some cases angioedema occurred after the first dose. Angioedema associated with upper airway swelling may be life threatening. If involvement of the tongue, hypopharynx, or larynx occurs, VESIcare should be promptly discontinued and appropriate therapy and/or measures necessary to ensure a patent airway should be promptly provided.
VESIcare should be administered with caution to patients with bladder outflow obstruction, decreased gastrointestinal motility, controlled narrow-angle glaucoma, or reduced renal or hepatic function. Doses of VESIcare higher than 5 mg are not recommended in patients with severe renal impairment, moderate hepatic impairment, or when administered with ketoconazole or other potent CYP3A4 inhibitors. Use of VESIcare in patients with severe hepatic impairment is not recommended.
In placebo-controlled studies, the most common adverse events reported by patients were dry mouth (10.9%, 27.6%, 4.2%), constipation (5.4%, 13.4%, 2.9%), blurred vision (3.8%, 4.8%, 1.8%), and dyspepsia (1.4%, 3.9%, 1.0%) with VESIcare 5 mg, 10 mg, and placebo, respectively.
The overall rate of serious adverse events was 2%. For the 10-mg dose, three intestinal serious adverse events were reported (one fecal impaction, one colonic obstruction, and one intestinal obstruction). For the 5-mg dose, one case of angioneurotic edema was reported.
