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CommercialDocumentationMedium impact

08.01.07l, Pertuzumab (Perjeta®) and related biosimilar pertuzumab-dpzb​ (Poherdy​)

Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Jul 27, 2026
We identified it
Jul 28, 2026
Days to comply
—

Summary

Policy 08.01.07l has been updated to reflect changes in medical necessity criteria and medical coding requirements for Pertuzumab (Perjeta®) and its biosimilar pertuzumab-dpzb (Poherdy®). The billing team must review updated medical necessity documentation requirements and coding guidance to ensure compliant claim submission on commercial plans effective immediately.

Action Required

Action needed
By 2026-07-27: Billing team must access the full policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#commercial-08-01-07l to review specific medical necessity criteria and coding changes for Pertuzumab and pertuzumab-dpzb. Update billing software rules and encounter forms to reflect new coding requirements. Coordinate with oncology providers to ensure claims include required medical necessity documentation. Failure to comply with updated criteria may result in claim denials.

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