CommercialPrior AuthMedium impact
Zenocutuzumab-zbco (Bizengri) (CPB 1076, reviewed 2026-07-02)
Aetna·Oncology, Pulmonology, Gastroenterology·Medical Policy
Effective date
Mar 14, 2025
We identified it
Aug 19, 2026
Summary
Aetna has established new coverage criteria for zenocutuzumab-zbco (Bizengri), a bispecific antibody for NRG1 fusion-positive cancers. The policy covers three indications: advanced NSCLC, pancreatic adenocarcinoma, and biliary tract cancers, all requiring prior authorization, documented NRG1 gene fusion testing, prior systemic therapy progression, and single-agent use. Billing teams must implement precertification requirements and use the new HCPCS code J9382 for claims.
Action Required
IMMEDIATE (effective 2025-03-14): 1) Billing team must configure billing system to require prior authorization (precertification) for all zenocutuzumab-zbco (Bizengri) claims before submitting. Contact Aetna at (866) 752-7021 or fax (888) 267-3277 for precertification; obtain SMN forms from Specialty Pharmacy Precertification. 2) Add HCPCS code J9382 (Injection, zenocutuzumab-zbco, 1 mg) to billing system with linked CPT codes 96413 and 96415 for infusion administration. 3) Providers must verify patient has documented NRG1 gene fusion testing before submitting claims—claims will be denied without evidence of positive NRG1 testing. 4) Confirm indication is limited to covered diagnoses only (advanced NSCLC, pancreatic adenocarcinoma, or biliary tract cancer) with documented disease progression after prior systemic therapy and single-agent use. 5) Front desk and billing staff must screen all Bizengri requests against these criteria before routing to precertification. Claims submitted without precertification or missing required documentation will be denied.