Medicare AdvantageCoverageHigh impact
MA08.148c, Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™)
Independence Blue Cross·Oncology, Pulmonology, Pharmacy·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA08.148c has been superseded by MA08.148d, effective 04/20/2026. The update adds a new subcutaneous formulation (Rybrevant Faspro™), expands coverage to include CNS/brain metastases, and revises subsequent-therapy regimens to include lazertinib while removing certain EGFR mutation types. Billing teams must update coding systems and prior authorization workflows to reflect the new HCPCS code J9062 and expanded clinical criteria.
Action Required
By April 20, 2026: (1) Billing team must update billing system to recognize and process new HCPCS code J9062 (Injection, amivantamab 5 mg and hyaluronidase-lpuj) for Rybrevant Faspro™ subcutaneous formulation alongside existing J9061 code. (2) Update prior authorization workflows to include new clinical criteria: subsequent-line amivantamab + lazertinib after osimertinib, and amivantamab + lazertinib after (platinum)/osimertinib/pemetrexed regimens. (3) Remove EGFR S768I, L861Q, and G719X from prior authorization approval criteria for subsequent therapy. (4) Add CNS/brain metastases as a new covered indication and update claim adjudication rules to allow coverage for this indication. (5) Update encounter forms and provider documentation templates to reflect expanded indications. (6) Train billing staff on distinction between IV formulation (J9061) and subcutaneous formulation (J9062) to ensure correct coding. Failure to implement these changes will result in claim denials for the new subcutaneous formulation and incorrect authorization decisions.