CommercialPrior AuthMedium impact
08.00.87p, Pemetrexed (Pemfexy™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
The policy for Pemetrexed (Pemfexy™) has been updated with changes to medical necessity criteria and medical coding requirements. This affects how the cancer treatment drug is billed and what documentation is required for coverage approval.
Action Required
By June 15, 2026: Billing team must review and implement updated medical necessity criteria for Pemetrexed (Pemfexy™). Update prior authorization requirements and coding guidelines in billing system. Providers must ensure documentation meets new medical necessity criteria before submitting claims.