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Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
Effective date
Not stated in the notice
Identified
Aug 13, 2026
Summary
Aetna considers albumin-bound paclitaxel (Abraxane or generic albumin-bound paclitaxel) medically necessary for the cancers listed in its initial approval criteria, including Kaposi sarcoma, breast cancer, cutaneous melanoma, endometrial carcinoma, ovarian, fallopian tube and primary peritoneal cancer, biliary tract cancers, non-small cell lung cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, uveal melanoma, ampullary adenocarcinoma, cervical cancer, bladder cancer and vaginal cancer, when each cancer's stated criteria are met. All other indications are considered experimental, investigational, or unproven, including small cell lung cancer, prostate cancer, soft-tissue sarcoma and gastric cancer. Continuation of therapy is medically necessary for an approved indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
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What to do
Action · 10 steps
01Covered for commercial medical plans when each cancer's initial approval criteria are met: Kaposi sarcoma; breast cancer that is recurrent or metastatic, has no response to preoperative systemic therapy, or where albumin-bound paclitaxel substitutes for paclitaxel or docetaxel because of hypersensitivity or contraindication to standard hypersensitivity premedications; subsequent treatment of metastatic or unresectable cutaneous melanoma, alone or with carboplatin; subsequent single-agent treatment of endometrial carcinoma; epithelial ovarian, fallopian tube or primary peritoneal cancer that is persistent or recurrent, or where it substitutes for paclitaxel due to hypersensitivity; biliary tract cancer with gemcitabine when unresectable, R2 or metastatic, or as neoadjuvant therapy for resectable locoregionally advanced gallbladder cancer that does not present as jaundice; non-small cell lung cancer that is recurrent, advanced or metastatic, or where it substitutes for paclitaxel or docetaxel due to hypersensitivity; pancreatic adenocarcinoma with gemcitabine with or without cisplatin; advanced or metastatic small bowel adenocarcinoma; uveal melanoma that is metastatic or unresectable; ampullary adenocarcinoma with gemcitabine; subsequent single-agent treatment of persistent, recurrent or metastatic cervical cancer; subsequent treatment of platinum-resistant locally advanced or metastatic bladder cancer; and subsequent single-agent treatment of recurrent or metastatic vaginal cancer.
02Claims for these need documentation that the criteria for the specific cancer are met.
03HCPCS J9264 (injection, paclitaxel protein-bound particles, 1 mg) is covered when those selection criteria are met.
04Dosing: 260 mg/m2 intravenously over 30 minutes every 3 weeks for metastatic breast cancer; 100 mg/m2 intravenously over 30 minutes on days 1, 8 and 15 of each 21-day cycle, with carboplatin given on day 1 immediately after, for non-small cell lung cancer; and 125 mg/m2 intravenously over 30 to 40 minutes on days 1, 8 and 15 of each 28-day cycle, with gemcitabine given immediately after, for pancreatic adenocarcinoma.
05Dose adjustments vary by indication and are described in the full prescribing information.
06ICD-10 codes C33 through C34.92 are covered for non-small cell lung cancer but not for small cell lung cancer.
07ICD-10 codes C43.0 through C43.9 and D03.0 through D03.9 for melanoma are not covered for hepatic arterial infusion of albumin-bound paclitaxel for metastatic melanoma to the liver.
08Hepatic arterial infusion for metastatic melanoma to the liver is experimental, investigational, or unproven.
09The combination of albumin-bound paclitaxel and sintilimab is experimental, investigational, or unproven for gastric cancer and soft tissue sarcoma.
10Medicare criteria are not in this policy and are found in the separate Medicare Part B criteria.
Codes mentioned
963659636696367963689641396417J9264J9045J9060J9171J9172J9184J9196J9201J9267J9355C17.0C17.9C22.0C22.1C23C22.2C22.9C24.0C24.1C24.8C24.9C25.0C25.9C33C34.00C34.92C43.0C43.9D03.0D03.9C46.0C46.9C48.1C48.8C50.011C50.A2C52C53.0C53.9C54.1C54.2C54.9C56.1C57.4C57.00C57.02C65.1C65.9C66.1C66.9C67.0C67.9C69.40C69.42D06.0D06.9C07C11.0C11.9C15.3C15.9C16.0C16.9C21.0C21.1C37C40.00C41.9C45.0C49.0C49.9C51.9C61C64.1C64.9C68.0C71.0C71.9C73C74.00C74.92C76.0C78.6C78.7C80.0C80.1C81.00C88.4C90.00C90.02D07.1
Original notice
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
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Aetna policiesOncologyCode 96365Code 96366Code 96367Code 96368Code 96413Code 96417Code J9264Code J9045Code J9060Code J9171Code J9172Code J9184Code J9196Code J9201Code J9267Code J9355Code C17.0Code C17.9Code C22.0Code C22.1Code C23Code C22.2Code C22.9Code C24.0Code C24.1Code C24.8Code C24.9Code C25.0Code C25.9Code C33Code C34.00Code C34.92Code C43.0Code C43.9Code D03.0Code D03.9Code C46.0Code C46.9Code C48.1Code C48.8Code C50.011Code C50.A2Code C52Code C53.0Code C53.9Code C54.1Code C54.2Code C54.9Code C56.1Code C57.4Code C57.00Code C57.02Code C65.1Code C65.9Code C66.1Code C66.9Code C67.0Code C67.9Code C69.40Code C69.42Code D06.0Code D06.9Code C07Code C11.0Code C11.9Code C15.3Code C15.9Code C16.0Code C16.9Code C21.0Code C21.1Code C37Code C40.00Code C41.9Code C45.0Code C49.0Code C49.9Code C51.9Code C61Code C64.1Code C64.9Code C68.0Code C71.0Code C71.9Code C73Code C74.00Code C74.92Code C76.0Code C78.6Code C78.7Code C80.0Code C80.1Code C81.00Code C88.4Code C90.00Code C90.02Code D07.1