CommercialCoverageMedium impact
Ziv-Aflibercept (Zaltrap) (CPB 0842, reviewed 2025-12-09)
Aetna·Oncology, Ophthalmology, Endocrinology·Medical Policy
We identified it
Aug 19, 2026
Summary
Aetna's updated Ziv-Aflibercept (Zaltrap) policy clarifies coverage is limited to advanced or metastatic colorectal cancer (including anal and appendiceal adenocarcinoma) in combination with FOLFIRI or irinotecan. All other indications—including breast cancer, lung cancer, ovarian cancer, pancreatic cancer, and numerous others—remain experimental/investigational and are not covered. This policy maintains existing restrictions with no new coverage expansions.
Action Required
IMMEDIATELY: Billing team must implement claim review procedures to ensure Zaltrap (J9400) claims are submitted ONLY for advanced or metastatic colorectal cancer (ICD-10: C18.0-C18.9, C19, C20, C21.0-C21.8), anal adenocarcinoma, or appendiceal adenocarcinoma. REJECT or DENY any Zaltrap claims for all other cancer types (breast, lung, ovarian, pancreatic, melanoma, lymphoma, leukemia, renal cell, prostate, bladder, thyroid, glioblastoma, sarcomas) and non-cancer indications (diabetic macular edema, age-related macular degeneration, retinal/chorioretinal conditions). Update billing system edits to flag Zaltrap claims with non-covered ICD-10 codes. Verify prior authorization is obtained for all covered CRC indications before claim submission. Notify oncology providers that off-label uses are not covered. Any claims submitted for experimental/investigational indications will be denied by Aetna.