From ordering, to setup, to patient assistance, getting your patients started on RELiZORB is easy with the information and instructions you’ll find below.
What’s needed to enroll patients?
You and your patient (or their representative) can work together to complete the required forms; just follow these 3 easy steps:
A copy of each form can be found below:
Please see below for links to sample Letters of Medical Necessity to request approval for use of and subsequent payment for RELiZORB on behalf of your patient. Please note: one form is specific for patients with cystic fibrosis, the other is not. The prescriber must modify the sample letter to be appropriate for the particular patient as the prescriber deems appropriate in his or her professional discretion.
If you have a patient(s) that has been denied coverage for RELiZORB by their insurance company, you may find the “Common Payer Questions and Objections to Covering RELiZORB” document below useful. The document is intended to provide Physicians, Registered Dieticians, and other HCPs who treat patients, that may benefit from the inclusion of RELiZORB as part of an enteral nutrition regimen, with possible responses to questions and objections frequently expressed by insurers/payers in deciding whether to cover RELiZORB. This document is provided for informational purposes only and its use does not guarantee that reimbursement for RELiZORB for a particular patient will be obtained. This document is intended for use with insurers/payers only.
ORDERING IS EASY
For hospitals ordering RELiZORB, refer to the information below.
RELiZORB is supplied in boxes of 30 cartridges: 1 box = 30 cartridges.
The RELiZORB NDC* is 62205000020, and the UDI is 00862205000243.
|Cardinal (Drug side)||5206982|
|Cardinal (Medical/Surgical side)||100295|
|McKesson (Drug side)||3507662|
|McKesson (Medical/Surgical side)||23564601|
|Morris & Dickson||245555|
*Third-party-derived code based on UDI.
To order RELiZORB directly from Alcresta Therapeutics, please send your PO to the following email: GMB-SPS-ALCRESTA@cordlogistics.com. GPOs we currently contract with include Vizient, Intalere, and Premier. For pricing information outside those GPOs, or other hospital ordering related questions, please contact Hospital Order Support at 1-844-632-9271.
HCPCS BILLING CODE
Effective January 1, 2019, RELiZORB has a permanent, separately billable Medicare billing code (B4105). In addition, RELiZORB was assigned the PE04 (Enteral Equipment and/or Supplies) Product and Service Code, which may be relevant for certain patients under the July 11, 1984, Medicare National Coverage Determination for Enteral and Parenteral Nutritional Therapy (180.2).
Additional resources you may find helpful for implementing RELiZORB into your hospital:
Click to view formulas and pumps that have been evaluated for use with RELiZORB in both the single and tandem configurations.
View a patient-friendly video to understand how to connect and use RELiZORB.
Patients and patient caregivers should review the following RELiZORB installation instructions before use.
FIGURE 1: Securing RELiZORB inlet to outlet fitting from pump tubing.
NOTE: Do not overtighten the enteral feeding pump tubing set fitting when connecting to RELiZORB. A small gap between the flange on the pump tube fitting and the RELiZORB is normal.
FIGURE 2: Connecting RELiZORB outlet to inlet fitting of patient extension set or enteral feeding tube that connects to patient.
WARNING: If medications, saline flushes or other non-enteral formula materials are to be added, they must be introduced AFTER RELiZORB (ie, between RELiZORB and the patient). They may be added to the side-port of a Y-Connector extension set located between the RELiZORB and the patient as shown in Figure 3.
FIGURE 3: Medications may be added between RELiZORB and patient.
NOTE: If medications or flush solutions are added BEFORE the RELiZORB cartridge, then RELiZORB, all tubing and formula must be discarded. You may re-start feeding using a new RELiZORB and a patient extension set. Please follow Steps 1-7 to re-start the process.
NOTE: If a second RELiZORB is required to be installed to replace an existing RELiZORB, use the following steps:
For volumes greater than 500 mL and up to 1000 mL, you can connect 2 RELiZORBs together in a tandem configuration. The tandem configuration (2 cartridges) is limited to 1 such use per day. Tandem RELiZORB may also be referred to as “piggybacking.”
TANDEM RELiZORB SETUP PROCEDURE AND USE
FIGURE 1: Connecting RELiZORB cartridges together to form a tandem RELiZORB.
FIGURE 2: Securing tandem RELiZORB inlet to outlet fitting from pump tubing.
FIGURE 3: Connecting tandem RELiZORB outlet to inlet fitting of tube that connects to patient.
FIGURE 4: Medications may be added between the tandem RELiZORB and patient.
NOTE: If medications or flush solutions are added BEFORE the tandem RELiZORB, then both RELiZORB cartridges, all tubing and formula must be discarded. You may re-start feeding using 2 new RELiZORBs and a patient extension set. Please follow Steps 1-7 above to re-start the process.
RELiZORB is now compatible with ENFit — the new standard in enteral connectors.
RELiZORB is a first-of-its-kind digestive enzyme cartridge designed to hydrolyze available fats in enteral formulas — immediately prior to ingestion.
ENFit is the new ISO 80369-3 standard for enteral connectors designed to help reduce the risk of enteral feeding misconnections and improve patient safety. The ENFit connector helps ensure that connectors do not connect to ports other than ENFit compatible enteral feeding connectors.