CommercialBilling CodesHigh impact
08.01.07l, Pertuzumab (Perjeta®) and related biosimilar pertuzumab-dpzb (Poherdy)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Jul 27, 2026
We identified it
Jul 28, 2026
Summary
Independence Blue Cross updated policy 08.01.07l to add coverage for Poherdy (pertuzumab-dpzb), the first FDA-approved biosimilar to Perjeta, effective July 27, 2026. Two new HCPCS codes (C9399 and J3590) were added to represent Poherdy claims. Coverage criteria were also updated to align with current FDA labeling and NCCN guidelines for breast cancer, CNS, colon, appendiceal, biliary, and rectal cancers.
Action Required
By July 27, 2026: (1) Billing team must update billing software to recognize and process HCPCS codes C9399 (Unclassified drugs or biologicals) and J3590 (Unclassified biologics) for Poherdy (pertuzumab-dpzb) claims. (2) Update claim submission logic to treat C9399 and J3590 as equivalent to J9306 (pertuzumab) for reimbursement purposes. (3) Verify that the EMR/billing system can identify when Poherdy is being billed versus the original Perjeta (J9306) to ensure accurate coding. (4) Train billing staff and providers on the new biosimilar codes and that Poherdy is an interchangeable product with identical coverage criteria. (5) Confirm that prior authorization workflows, if applicable, accept both the original and biosimilar codes. Failure to update billing systems by the effective date will result in claim rejections for Poherdy administrations.