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Independence Blue CrossCommercial · Coverage · Pharmacy · Oncology, Hematology, PharmacyMedium impact

08.00.87p, Pemetrexed (Pemfexy™)

Act
by Jun 15, 2026
Effective date
Jun 15, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated pemetrexed (Pemfexy) policy 08.00.87p to align with FDA labeling and NCCN guidelines, adding coverage for Malignant Peritoneal Mesothelioma subtypes and Low-Grade Serous Carcinoma, while removing non-specific lung cancer ICD-10 codes and the Head and Neck Cancer indication. Billing teams must update diagnosis code requirements and remove deprecated codes from claim submissions.

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What to do

by Jun 15, 2026 · 6 steps
01Billing team must update claim submission protocols for pemetrexed (Pemfexy) HCPCS code J9304.
02REMOVE the following deprecated ICD-10 diagnosis codes from approved code lists: C34.00, C34.10, C34.30, C34.80, C34.90, C56.9, C57.00, and any Head and Neck Cancer codes.
03ADD the following newly covered ICD-10 diagnosis codes to approved code lists: C45.2 (Mesothelioma of pericardium), C45.7 (Mesothelioma of other sites), C45.9 (Mesothelioma unspecified).
04Update billing software validation rules to accept only approved diagnosis codes for J9304 claims.
05Educate providers and clinical staff that Head and Neck Cancer is no longer a covered indication for pemetrexed—claims for this indication will be denied.
06Ensure prior authorization templates reflect new covered indications including Malignant Peritoneal Mesothelioma (Sarcomatoid, Epithelioid, Biphasic, Benign Multicystic, Well-Differentiated Papillary) and Low-Grade Serous Carcinoma.
If missed: Failure to remove deprecated codes will result in claim denials; failure to add new codes will delay approval for newly covered indications.

Codes mentioned

J9304C45.2C45.7C45.9

Original notice

08.00.87p, Pemetrexed (Pemfexy™)
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

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MA08.072o, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseHighEffective Jan 1, 2025 · Pharmacy08.00.66w, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMediumEffective Jan 1, 2025 · PharmacyMA08.047n, Pemetrexed (Pemfexy™)MediumEffective Jun 15, 2026 · Pharmacy08.00.87o, Pemetrexed (Pemfexy™)MediumEffective Jun 15, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyHematologyPharmacyCode J9304Code C45.2Code C45.7Code C45.9

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