All PlansCoverageMedium impact
Pemetrexed (Alimta®; Pemfexy™, Pemetrexed™, Pemrydi RTU, Axtle™)
BCBS Tennessee·Oncology, Hematology, Pulmonology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
This policy establishes comprehensive coverage criteria for pemetrexed (Alimta and other brands) for various cancers including non-squamous NSCLC, mesothelioma, and multiple other oncologic conditions. The policy includes detailed authorization requirements, medication quantity limits, and exclusions for squamous cell NSCLC.
Action Required
Before June 30, 2026: Oncology billing teams must update prior authorization workflows for pemetrexed (Alimta, Pemfexy, Pemetrexed, Pemrydi RTU, Axtle) to ensure compliance with new coverage criteria. Update systems to flag squamous cell NSCLC as excluded indication. Prepare documentation templates for the 11 covered cancer types with specific authorization requirements. Train staff on 6-month authorization periods and continuation criteria based on treatment response and toxicity.