CommercialCoverageHigh impact
08.01.90c, Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™)
Independence Blue Cross·PA · Oncology, Pharmacy, Pulmonology·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross added a new subcutaneous formulation (Rybrevant Faspro™) to policy 08.01.90c effective 04/20/2026, expanded coverage to include CNS/brain metastases, updated subsequent-line therapy regimens to include lazertinib combinations, and added new HCPCS billing codes J9062 and C9399/J3590 for the new formulation.
Action Required
By April 20, 2026: Billing team must update billing software to recognize and process HCPCS codes J9062 (Injection, amivantamab 5 mg and hyaluronidase-lpuj for Rybrevant Faspro™ SC formulation), C9399, and J3590 (Unclassified biologics). Update prior authorization systems to reflect expanded coverage criteria including: (1) new CNS/brain metastases indication with amivantamab + lazertinib or amivantamab + carboplatin/pemetrexed; (2) subsequent-line therapy regimens now including lazertinib combinations after osimertinib or platinum/osimertinib/pemetrexed (removed EGFR S768I, L861Q, and G719X criteria). Providers must document which amivantamab formulation (IV J9061 vs. SC J9062) is being administered and confirm medical necessity per updated NCCN-aligned criteria. Update encounter documentation templates to capture CNS/brain metastases status when applicable. Claims submitted with incorrect formulation codes or without updated medical necessity documentation will be denied.