Medicare AdvantageCoverageMedium impact
MA08.047n, Pemetrexed (Pemfexy™)
Independence Blue Cross·Oncology·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.047n for Pemetrexed (Pemfexy™) has been updated with changes to medical necessity criteria and medical coding requirements. This affects pharmacy billing for this cancer chemotherapy drug under Medicare Advantage plans.
Action Required
Before June 15, 2026: Billing team and oncology providers must review updated medical necessity criteria for Pemetrexed (Pemfexy™) and update any coding requirements in billing system. Access the full policy at the provided URL to understand specific documentation and coding changes. Ensure prior authorization processes align with new medical necessity criteria to prevent claim denials.