Effective November 7, 2022, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators will update their medical policy on Pemetrexed (Alimta®), Pemetrexed (Pemfexy™) for Commercial members.
The medical necessity criteria will be revised to reflect the National Comprehensive Cancer Network (NCCN) compendia for Nonsquamous Non-Small Cell Lung Cancer (NSCLC) and Ovarian cancer, Fallopian Tube Cancer, and Peritoneal Cancer, including the additional indication of Malignant Peritoneal Mesothelioma (Sarcomatoid, Epithelioid, Biphasic, Benign Multicystic, Well-Differentiated Papillary) and Low-Grade Serous Carcinoma.
The following ICD-10 codes will be removed from this policy:
- C34.00 Malignant neoplasm of unspecified main bronchus
- C34.10 Malignant neoplasm of upper lobe, unspecified bronchus or lung
- C34.30 Malignant neoplasm of lower lobe, unspecified bronchus or lung
- C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung
- C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung
- C56.9 Malignant neoplasm of unspecified ovary
- C57.00 Malignant neoplasm of unspecified fallopian tube
- C57.10 Malignant neoplasm of unspecified broad ligament
- C57.20 Malignant neoplasm of unspecified round ligament
- D15.0 Benign neoplasm of thymus
The following ICD-10 codes will be added to this policy:
- C45.2 Mesothelioma of pericardium
- C45.7 Mesothelioma of other sites
- C45.9 Mesothelioma, unspecified
For more information, please refer to the policy notification published on October 7, 2022.