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Abraxane® (paclitaxel protein-bound particles) (Intravenous)

Policy Number: VP-0001

Last Review Date: 09/03/2019

Date of Origin:  10/17/2008

Dates Reviewed: 06/2009, 12/2009, 07/2010, 09/2010, 12/2010, 03/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 11/2012, 12/2012, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 05/2015, 08/2015, 11/2015, 02/2016, 05/2016, 08/2016, 11/2016, 02/2017, 05/2017, 08/2017, 11/2017, 02/2018, 04/2018, 05/2018, 09/2018, 12/2018, 03/2019, 06/2019, 09/2019

 

I. Length of Authorization

Coverage is provided for 6 months and may be renewed.

II. Dosing Limits

  1. Quantity Limit (max daily dose) [Pharmacy Benefit]:
  • Abraxane 100 mg powder for injection SDV: 9 vials per 21 day supply
  1. Max Units (per dose and over time) [Medical Benefit]:

All indications

  • 900 billable units per 21 days

III. Initial Approval Criteria

Coverage is provided in the following conditions:

  • Patient is 18 years of age or older; AND

Breast cancer †

  • Patient failed on combination chemotherapy for metastatic disease or relapsed within 6 months of adjuvant therapy; AND
  • Previous chemotherapy included an anthracycline

-OR -‡

  • Patient’s disease is recurrent or metastatic; AND
    • Used as a single agent therapy for disease that is HER2-negative; AND
      • Disease is hormone receptor negative; OR
      • Disease is hormone receptor positive and patient is refractory to endocrine therapy or has a visceral crisis; OR
    • Used in combination with trastuzumab for disease that is HER2-positive; AND
      • Disease is hormone receptor negative; OR
      • Disease is hormone receptor positive and used with or without endocrine therapy

-OR-

  • Used as preferred therapy in combination with atezolizumab for PD-L1 positive triple negative recurrent or stage IV (M1) disease

-OR-

  • May be substituted for paclitaxel or docetaxel if patient has experienced hypersensitivity reactions despite premedication or the patient has contraindications to standard hypersensitivity premedication.

Non-small cell lung cancer †

  • Used as first-line therapy for locally advanced or metastatic disease, in combination with carboplatin, in patients who are not candidates for curative surgery or radiation therapy ; OR
  • Used for recurrent, advanced or metastatic disease (excluding locoregional recurrence or symptomatic local disease with no evidence of disseminated disease); AND
      • Used as a single agent in patients with a PS score of 2; OR
      • Used in combination with carboplatin with a PS score of ≤2; OR
      • Used in combination with pembrolizumab AND carboplatin or cisplatin with a PS score of ≤1 in patients with squamous cell histology; AND
        • Used as first-line therapy for patients who are genomic tumor aberration (e.g., EGFR, ALK, ROS1, BRAF and PD-L1) negative or unknown; OR
        • Patients are BRAF V600E-mutation positive; OR
        • Used as subsequent therapy for patients are genomic tumor aberration (e.g., EGFR, ALK, and ROS1) positive and received targeted therapies for those aberrations; OR
        • Used as subsequent therapy for PD-L1 expression-positive (≥1%) tumors and are EGFR, ALK negative or unknown with no prior platinum-doublet chemotherapy; OR
      • Used in combination with pembrolizumab AND carboplatin or cisplatin with a PS score of ≤2 in patients with squamous cell histology; AND
        • Used as first-line therapy for PD-L1 expression positive (≥1%) tumors that are genomic tumor aberration EGFR and ALK negative or unknown
    • -OR-

  • May be substituted for paclitaxel or docetaxel if patient has experienced hypersensitivity reactions despite premedication or the patient has contraindications to standard hypersensitivity premedication.

Ovarian cancer (Epithelial/Fallopian Tube/Primary Peritoneal)

  • Patient’s disease is recurrent or persistent; AND
  • Patient is not experiencing an immediate biochemical relapse; AND
    • Must be used as a single agent; OR
    • Used in combination with carboplatin if platinum-sensitive with confirmed taxane hypersensitivity

Pancreatic Adenocarcinoma †

  • Must be used in combination with gemcitabine; AND
    • Patient’s disease is locally advanced or metastatic; AND
      • Patient has good performance status (defined as an ECOG PS ≤2); AND
        • Used as first-line or induction therapy; OR
        • Used as second-line therapy after progression with a fluoropyrimidine-based therapy; OR
    • Patient’s disease is recurrent; AND
      • Used as second-line therapy
    • Patient’s disease is resectable with high-risk features (i.e., very highly elevated CA 19-9, large primary tumors, large regional lymph nodes, excessive weight loss, extreme pain) or borderline resectable; AND
      • Used for neoadjuvant treatment

Melanoma

  • Must be used as a single agent; AND
  • Patient’s disease must be unresectable or metastatic; AND
    • Patient has uveal melanoma; OR
    • Used as subsequent therapy for disease progression or after maximum clinical benefit from BRAF targeted therapies

Bladder Cancer/Urothelial Carcinoma

  • Must be used as a single agent; AND
  • Must be used subsequently following prior treatment with a systemic therapy (i.e., platinum or checkpoint inhibitor); AND
  • Patient has a diagnosis of one the following:
  • Locally advanced or metastatic disease; OR
  • Disease recurrence post-cystectomy; OR
  • Metastatic Upper GU tract tumors; OR
  • Metastatic Urothelial Carcinoma of the Prostate; OR
  • Recurrent or metastatic Primary Carcinoma of the Urethra; AND
      • Patient does not have recurrent stage T3-4 disease or palpable inguinal lymph nodes

Uterine Cancer

  • Used as single agent therapy; AND
  • Patient has endometrial carcinoma; AND
    • Used as primary treatment for one of the following:
      • Metastatic disease; OR
      • Unresectable disease excluding patients using chemotherapy alone for disease not suitable for primary surgery with suspected or gross cervical involvement; OR
      • Used preoperatively for patients with locally confined disease that is suitable for primary surgery; OR
    • Adjuvant treatment, excluding patients with Stage II disease and histologic grade 3 tumors; OR
    • Used as treatment of local-regional recurrent, progressive or disseminated metastatic disease; OR
    • Used as additional treatment of disease suitable for primary surgery; AND
  • Patient has tried generic paclitaxel and treatment with paclitaxel was not tolerated due to a documented hypersensitivity reaction, despite use of recommended premedication or there is a documented medical contraindication to recommended premedication.

Hepatobiliary Cancer (Intrahepatic/Extrahepatic Cholangiocarcinoma)

  • Must be used in combination with gemcitabine; AND
  • Used as primary treatment for unresectable or metastatic disease

Small Bowel Adenocarcinoma ‡

  • Patient has advanced or metastatic disease; AND
  • Used as single agent or in combination with gemcitabine; AND
    • Used as initial therapy in patients with disease that is microsatellite stable or proficient mismatch repair [MSS or pMMR] who have had prior oxaliplatin exposure as adjuvant therapy or there is a contraindication to it; OR
    • Used as subsequent therapy; AND
      • Patient has disease that is proficient microsatellite stable or proficient mismatch repair [MSS or pMMR], in which intensive therapy is appropriate OR patient has progressed through FOLFOX, irinotecan, or clinical trial; OR
      • Patient has disease that is deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) that has progressed through pembrolizumab, nivolumab, or clinical trial OR patient had prior adjuvant oxaliplatin exposure, or there is a contraindication to it and progression through pembrolizumab, nivolumab, or clinical trial.

AIDS-related Kaposi Sarcoma

  • Must be used as subsequent therapy in combination with antiretroviral therapy (ART); AND
  • Patient has relapsed/refractory advanced, cutaneous, oral, visceral, or nodal disease; AND
  • Patient had disease progression after first-line and alternate first-line treatment

FDA Approved Indication(s), Compendia recommended indication(s)

Genomic Aberration Targeted Therapies (not all inclusive) §

Sensitizing EGFR mutation-positive tumors

  • Erlotinib
  • Afatinib
  • Gefitinib
  • Osimertinib
  • Dacomitinib

ALK rearrangement-positive tumors

  • Crizotinib
  • Ceritinib
  • Brigatinib
  • Alectinib
  • Lorlatinib

ROS1 rearrangement-positive tumors

  • Crizotinib
  • Ceritinib

BRAF V600E-mutation positive tumors

  • Dabrafenib/Trametinib

NTRK Gene Fusion positive tumors

  • Larotrectinib

PD-L1 expression-positive tumors (≥1%)

  • Pembrolizumab
  • Atezolizumab

 

IV. Renewal Criteria

Coverage can be renewed based upon the following criteria:

  • Patient continues to meet criteria identified in section III; AND
  • Disease response with treatment as defined by stabilization of disease or decrease in size of tumor or tumor spread; AND
  • Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: neutrophil counts of < 1,500 cell/mm3, sensory neuropathy, sepsis, pneumonitis, severe hypersensitivity reactions, myelosuppression, hepatic impairment, etc.

V. Dosage/Administration

Indication

Dose

Pancreatic Cancer and Hepatobiliary Cancer

125 mg/m² days 1, 8, and 15 of a 28-day cycle

All other indications

260 mg/m² every 21 days

OR

100 mg/m² days 1, 8, and 15 of a 21-day cycle

 

VI. Billing Code/Availability Information

Jcode:

  • J9264 – Injection, paclitaxel protein-bound particles, 1 mg; 1 billable unit = 1 mg

NDC:

  • Abraxane 100 mg powder for injection; single-use vial: 68817-0134-xx

VII. References

  1. Abraxane [package insert]. Summit, NJ; Celgene Corporation; August 2018. Accessed July 2019.
  2. Referenced with permission from the NCCN Drugs and Biologics Compendium (NCCN Compendium®) paclitaxel, albumin bound. National Comprehensive Cancer Network, 2019. The NCCN Compendium® is a derivative work of the NCCN Guidelines®. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, and NCCN GUIDELINES® are trademarks owned by the National Comprehensive Cancer Network, Inc. To view the most recent and complete version of the Compendium, go online to NCCN.org. Accessed July 2019.
  3. Teneriello, MG et al. Phase II evaluation of nanoparticle albumin-bound paclitaxel in platinum-sensitive patients with recurrent ovarian, peritoneal, or fallopian tube cancer. J Clin Oncol. 2009 Mar 20; 27(9):1426-31. Epub 2009 Feb 17.
  4. Gradishar WJ, Krasnojon D, Cheporov S, et al, “Significantly Longer Progression-Free Survival With nab-paclitaxel Compared With Docetaxel as First-Line Therapy for Metastatic Breast Cancer,” J Clin Oncol, 2009, 27(22):3611-9.
  5. Rizvi NA, Riely GJ, Azzoli CG, et al, “Phase I/II Trial of Weekly Intravenous 130-nm Albumin-Bound Paclitaxel as Initial Chemotherapy in Patients With Stage IV Non-Small-Cell Lung Cancer,” J Clin Oncol, 2008, 26(4):639-43.
  6. Sahai V, Catalano PJ, Zalupski MM, et al. Nab-Paclitaxel and Gemcitabine as First-line Treatment of Advanced or Metastatic Cholangiocarcinoma: A Phase 2 Clinical Trial. JAMA Oncol. 2018;4(12):1707–1712. doi:10.1001/jamaoncol.2018.3277
  7. National Government Services, Inc. Local Coverage Article for Paclitaxel (e.g., Taxol®/Abraxane) related to LCD L33394 (A52450). Centers for Medicare & Medicaid Services, Inc. Updated on 07/26/2019 with effective date of 05/01/2019. Accessed August 2019.

Appendix 1 – Covered Diagnosis Codes

ICD-10

ICD-10 Description

 C17.0  Malignant neoplasm of duodenum
 C17.1  Malignant neoplasm of jejunum
 C17.2  Malignant neoplasm of ileum
 C17.3  Meckel's diverticulum, malignant
 C17.8  Malignant neoplasm of overlapping sites of small intestine
 C17.9  Malignant neoplasm of small intestine, unspecified

C22.1

Intrahepatic bile duct carcinoma

C24.0

Malignant neoplasm of extrahepatic bile duct

C24.8

Malignant neoplasm of overlapping sites of biliary tract

C24.9

Malignant neoplasm of biliary tract, unspecified

C25.0

Malignant neoplasm of head of pancreas

C25.1

Malignant neoplasm of body of the pancreas

C25.2

Malignant neoplasm of tail of pancreas

C25.3

Malignant neoplasm of pancreatic duct

C25.7

Malignant neoplasm of other parts of pancreas

C25.8

Malignant neoplasm of overlapping sites of pancreas

C25.9

Malignant neoplasm of pancreas, unspecified

C33

Malignant neoplasm of trachea

C34.00

Malignant neoplasm of unspecified main bronchus

C34.01

Malignant neoplasm of right main bronchus

C34.02

Malignant neoplasm of left main bronchus

C34.10

Malignant neoplasm of upper lobe, unspecified bronchus or lung

C34.11

Malignant neoplasm of upper lobe, right bronchus or lung

C34.12

Malignant neoplasm of upper lobe, left bronchus or lung

C34.2

Malignant neoplasm of middle lobe, bronchus or lung

C34.30

Malignant neoplasm of lower lobe, unspecified bronchus or lung

C34.31

Malignant neoplasm of lower lobe, right bronchus or lung

C34.32

Malignant neoplasm of lower lobe, left bronchus or lung

C34.80

Malignant neoplasm of overlapping sites of unspecified bronchus or lung

C34.81

Malignant neoplasm of overlapping sites of right bronchus and lung

C34.82

Malignant neoplasm of overlapping sites of left bronchus and lung

C34.90

Malignant neoplasm of unspecified part of unspecified bronchus or lung

C34.91

Malignant neoplasm of unspecified part of right bronchus or lung

C34.92

Malignant neoplasm of unspecified part of left bronchus or lung

C43.0

Malignant melanoma of lip

C43.10

Malignant melanoma of unspecified eyelid, including canthus

C43.11

Malignant melanoma of right eyelid, including canthus

C43.12

Malignant melanoma of left eyelid, including canthus

C43.20

Malignant melanoma of unspecified ear and external auricular canal

C43.21

Malignant neoplasm of right ear and external auricular canal

C43.22

Malignant neoplasm of left ear and external auricular canal

C43.30

Malignant melanoma of unspecified parts of face

C43.31

Malignant melanoma of nose

C43.39

Malignant melanoma of other parts of face

C43.4

Malignant melanoma of scalp and neck

C43.51

Malignant melanoma of anal skin

C43.52

Malignant melanoma of skin of breast

C43.59

Malignant melanoma of other part of trunk

C43.60

Malignant melanoma of unspecified upper limb, including shoulder

C43.61

Malignant melanoma of right upper limb, including shoulder

C43.62

Malignant melanoma of left upper limb, including shoulder

C43.70

Malignant melanoma of unspecified lower limb, including hip

C43.71

Malignant melanoma of right lower limb, including hip

C43.72

Malignant melanoma of left lower limb, including hip

C43.8

Malignant melanoma of overlapping sites of skin

C43.9

Malignant melanoma of skin, unspecified

C46.0

Kaposi's sarcoma of skin

C46.1

Kaposi's sarcoma of soft tissue

C46.2

Kaposi's sarcoma of palate

C46.3

Kaposi's sarcoma of lymph nodes

C46.4

Kaposi's sarcoma of gastrointestinal sites

C46.50

Kaposi's sarcoma of unspecified lung

C46.51

Kaposi's sarcoma of right lung

C46.52

Kaposi's sarcoma of left lung

C46.7

Kaposi's sarcoma of other sites

C46.9

Kaposi's sarcoma, unspecified

C48.1

Malignant neoplasm of specified parts of peritoneum

C48.2

Malignant neoplasm of peritoneum, unspecified

C48.8

Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum

C50.011

Malignant neoplasm of nipple and areola, right female breast

C50.012

Malignant neoplasm of nipple and areola, left female breast

C50.019

Malignant neoplasm of nipple and areola, unspecified female breast

C50.021

Malignant neoplasm of nipple and areola, right male breast

C50.022

Malignant neoplasm of nipple and areola, left male breast

C50.029

Malignant neoplasm of nipple and areola, unspecified male breast

C50.111

Malignant neoplasm of central portion of right female breast

C50.112

Malignant neoplasm of central portion of left female breast

C50.119

Malignant neoplasm of central portion of unspecified female breast

C50.121

Malignant neoplasm of central portion of right male breast

C50.122

Malignant neoplasm of central portion of left male breast

C50.129

Malignant neoplasm of central portion of unspecified male breast

C50.211

Malignant neoplasm of upper-inner quadrant of right female breast

C50.212

Malignant neoplasm of upper-inner quadrant of left female breast

C50.219

Malignant neoplasm of upper-inner quadrant of unspecified  female breast

C50.221

Malignant neoplasm of upper-inner quadrant of right male breast

C50.222

Malignant neoplasm of upper-inner quadrant of left male breast

C50.229

Malignant neoplasm of upper-inner quadrant of unspecified male breast

C50.311

Malignant neoplasm of lower-inner quadrant of right female breast

C50.312

Malignant neoplasm of lower-inner quadrant of left female breast

C50.319

Malignant neoplasm of lower-inner quadrant of unspecified female breast

C50.321

Malignant neoplasm of lower-inner quadrant of right male breast

C50.322

Malignant neoplasm of lower-inner quadrant of left male breast

C50.329

Malignant neoplasm of lower-inner quadrant of unspecified male breast

C50.411

Malignant neoplasm of upper-outer quadrant of right female breast

C50.412

Malignant neoplasm of upper-outer quadrant of left female breast

C50.419

Malignant neoplasm of upper-outer quadrant of unspecified female breast

C50.421

Malignant neoplasm of upper-outer quadrant of right male breast

C50.422

Malignant neoplasm of upper-outer quadrant of left male breast

C50.429

Malignant neoplasm of upper-outer quadrant of unspecified male breast

C50.511

Malignant neoplasm of lower-outer quadrant of right female breast

C50.512

Malignant neoplasm of lower-outer quadrant of left female breast

C50.519

Malignant neoplasm of lower-outer quadrant of unspecified female breast

C50.521

Malignant neoplasm of lower-outer quadrant of right male breast

C50.522

Malignant neoplasm of lower-outer quadrant of left male breast

C50.529

Malignant neoplasm of lower-outer quadrant of unspecified male breast

C50.611

Malignant neoplasm of axillary tail of right female breast

C50.612

Malignant neoplasm of axillary tail of left female breast

C50.619

Malignant neoplasm of axillary tail of unspecified female breast

C50.621

Malignant neoplasm of axillary tail of right male breast

C50.622

Malignant neoplasm of axillary tail of left male breast

C50.629

Malignant neoplasm of axillary tail of unspecified male breast

C50.811

Malignant neoplasm of overlapping sites of right female breast

C50.812

Malignant neoplasm of overlapping sites of left female breast

C50.819

Malignant neoplasm of overlapping sites of unspecified female breast

C50.821

Malignant neoplasm of overlapping sites of right male breast

C50.822

Malignant neoplasm of overlapping sites of left male breast

C50.829

Malignant neoplasm of overlapping sites of unspecified male breast

C50.911

Malignant neoplasm of unspecified site of right female breast

C50.912

Malignant neoplasm of unspecified site of left female breast

C50.919

Malignant neoplasm of unspecified site of unspecified female breast

C50.921

Malignant neoplasm of unspecified site of right male breast

C50.922

Malignant neoplasm of unspecified site of left male breast

C50.929

Malignant neoplasm of unspecified site of unspecified male breast

C54.0

Malignant neoplasm of isthmus uteri

C54.1

Malignant neoplasm of endometrium

C54.2

Malignant neoplasm of myometrium

C54.3

Malignant neoplasm of fundus uteri

C54.8

Malignant neoplasm of overlapping sites of corpus uteri

C54.9

Malignant neoplasm of corpus uteri, unspecified

C55

Malignant neoplasm of uterus, part unspecified

C56.1

Malignant neoplasm of right ovary

C56.2

Malignant neoplasm of left ovary

C56.9

Malignant neoplasm of unspecified ovary

C57.00

Malignant neoplasm of unspecified fallopian tube

C57.01

Malignant neoplasm of right fallopian tube

C57.02

Malignant neoplasm of left fallopian tube

C57.10

Malignant neoplasm of unspecified broad ligament

C57.11

Malignant neoplasm of right broad ligament

C57.12

Malignant neoplasm of left broad ligament

C57.20

Malignant neoplasm of unspecified round ligament

C57.21

Malignant neoplasm of right round ligament

C57.22

Malignant neoplasm of left round ligament

C57.3

Malignant neoplasm of parametrium

C57.4

Malignant neoplasm of uterine adnexa, unspecified

C57.7

Malignant neoplasm of other specified female genital organs

C57.8

Malignant neoplasm of overlapping sites of female genital organs

C57.9

Malignant neoplasm of female genital organ, unspecified

C61

Malignant neoplasm of prostate

C65.1

Malignant neoplasm of right renal pelvis

C65.2

Malignant neoplasm of left renal pelvis

C65.9

Malignant neoplasm of unspecified renal pelvis

C66.1

Malignant neoplasm of right ureter

C66.2

Malignant neoplasm of left ureter

C66.9

Malignant neoplasm of unspecified ureter

C67.0

Malignant neoplasm of trigone of bladder

C67.1

Malignant neoplasm of dome of bladder

C67.2

Malignant neoplasm of lateral wall of bladder

C67.3

Malignant neoplasm of anterior wall of bladder

C67.4

Malignant neoplasm of posterior wall of bladder

C67.5

Malignant neoplasm of bladder neck

C67.6

Malignant neoplasm of ureteric orifice

C67.7

Malignant neoplasm of urachus

C67.8

Malignant neoplasm of overlapping sites of bladder

C67.9

Malignant neoplasm of bladder, unspecified

C68.0

Malignant neoplasm of urethra

C69.30

Malignant neoplasm of unspecified choroid

C69.31

Malignant neoplasm of right choroid

C69.32

Malignant neoplasm of left choroid

C69.40

Malignant neoplasm of unspecified ciliary body

C69.41

Malignant neoplasm of right ciliary body

C69.42

Malignant neoplasm of left ciliary body

C69.60

Malignant neoplasm of unspecified orbit

C69.61

Malignant neoplasm of right orbit

C69.62

Malignant neoplasm of left orbit

D09.0

Carcinoma in situ of bladder

Z85.07

Personal history of malignant neoplasm of pancreas

Z85.118

Personal history of other malignant neoplasm of bronchus and lung

Z85.3

Personal history of malignant neoplasm of breast

Z85.43

Personal history of malignant neoplasm of ovary

Z85.51

Personal history of malignant neoplasm of bladder

Z85.59

Personal history of malignant neoplasm of other urinary tract organ

Appendix 2 – Centers for Medicare and Medicaid Services (CMS)

Medicare coverage for outpatient (Part B) drugs is outlined in the Medicare Benefit Policy Manual (Pub. 100-2), Chapter 15, §50 Drugs and Biologicals. In addition, National Coverage Determination (NCD) and Local Coverage Determinations (LCDs) may exist and compliance with these policies is required where applicable. They can be found at: http://www.cms.gov/medicare-coverage-database/search/advanced-search.aspx. Additional indications may be covered at the discretion of the health plan.

Medicare Part B Covered Diagnosis Codes (applicable to existing NCD/LCD):

Jurisdiction(s): 6, K

NCD/LCD Document (s): A52450

https://www.cms.gov/medicare-coverage-database/search/article-date-search.aspx?DocID=A52450&bc=gAAAAAAAAAAAAA==  

Medicare Part B Administrative Contractor (MAC) Jurisdictions

Jurisdiction

Applicable State/US Territory

Contractor

E (1)

CA, HI, NV, AS, GU, CNMI

Noridian Healthcare Solutions, LLC

F (2 & 3)

AK, WA, OR, ID, ND, SD, MT, WY, UT, AZ

Noridian Healthcare Solutions, LLC

5

KS, NE, IA, MO

Wisconsin Physicians Service Insurance Corp (WPS)

6

MN, WI, IL

National Government Services, Inc. (NGS)

H (4 & 7)

LA, AR, MS, TX, OK, CO, NM

Novitas Solutions, Inc.

8

MI, IN

Wisconsin Physicians Service Insurance Corp (WPS)

N (9)

FL, PR, VI

First Coast Service Options, Inc.

J (10)

TN, GA, AL

Palmetto GBA, LLC

M (11)

NC, SC, WV, VA (excluding below)

Palmetto GBA, LLC

L (12)

DE, MD, PA, NJ, DC (includes Arlington & Fairfax counties and the city of Alexandria in VA)

Novitas Solutions, Inc.

K (13 & 14)

NY, CT, MA, RI, VT, ME, NH

National Government Services, Inc. (NGS)

15

KY, OH

CGS Administrators, LLC