CommercialDocumentationMedium impact
08.00.87o, Pemetrexed (Pemfexy™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.87o for Pemetrexed (Pemfexy™) has been updated with changes to medical necessity criteria and medical coding requirements effective November 17, 2025. The billing team must review the updated medical necessity guidelines and ensure coding practices align with the new policy to avoid claim denials.
Action Required
By November 17, 2025: Billing team and clinical staff must review the full policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=11&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-00-87o to identify specific medical necessity criteria changes and coding updates. Update billing software, encounter templates, and prior authorization guidelines accordingly. Ensure all Pemetrexed claims submitted on or after the effective date comply with the new medical necessity criteria. Document any changes in your compliance tracking system. Claims that do not meet the updated medical necessity requirements will be denied.