Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-10-16)

PRECERTIFICATION REQUIRED: Billing and authorization teams must obtain precertification from Aetna for all claims involving amivantamab-vmjw (Rybrevant) or amivantamab and hyaluronidase-lpuj (Rybrevant Faspro) before administering to members in applicable plan designs. Contact (866) 752-7021 or fax (888) 267-3277 for precertification. Verify medical necessity criteria are met: for EGFR Exon 19 Deletion or Exon 21 L858R mutation (combination with lazertinib, brain metastases treatment, or subsequent treatment regimens) or EGFR Exon 20 Insertion mutation (first-line combination with carboplatin/pemetrexed or subsequent single-agent use). Claims without precertification authorization will be denied. Staff should confirm baseline body weight at treatment initiation to verify correct dosing schedules for IV vs. subcutaneous administration. Gastro-esophageal cancer indications are not covered and should not be authorized.