Does J9303 require prior authorization?

Yes, J9303 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9303?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J9303`, Injection, panitumumab, 10 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Precertification documentation: use Aetna precertification process (phone (866) 752-7021 or fax (888) 267-3277) and submit Statement of Medical Necessity (SMN) precertification forms as required by Aetna.

Molecular testing results: RAS (KRAS and NRAS) mutation status (must be negative/wild-type for Criteria Set 1) — relevant CPT codes listed (e.g., 81275, 81276, 81311, 81210, 81404) to support testing.

If BRAF V600E positive: documentation of BRAF V600E test result and treatment plan showing panitumumab will be used in combination with encorafenib (Braftovi).

If KRAS G12C positive: documentation of KRAS G12C test result and treatment plan showing panitumumab will be used in combination with sotorasib (Lumakras) or adagrasib (Krazati), and documentation that the member previously received chemotherapy.

Tumor sidedness documentation for colon cancer: clear documentation that tumor is left-sided for colon cancer cases covered under Criteria Set 1.

Prior treatment history: records documenting prior chemotherapy regimens (including fluoropyrimidine, oxaliplatin, irinotecan exposure when relevant) and documentation that member "has not previously experienced clinical failure on cetuximab" when required by policy.

Key Coverage Criteria

Continuation of Therapy: "Aetna considers continuation of panitumumab (Vectibix) therapy medically necessary in members requesting reauthorization for an indication listed in Section I when there is no evidence of unacceptable toxicity or disease progression while on the current regimen."
FDA-Approved Indications (background information included in policy): "Vectibix is indicated for the treatment of patients with wild-type RAS (defined as wild-type in both KRAS and NRAS as determined by an FDA-approved test for this use) metastatic colorectal cancer (mCRC): As first-line therapy in combination with FOLFOX; As monotherapy following disease progression after prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy."
C18.0 - C18.9 Malignant neoplasm of colon [covered for left-sided tumors only]
C19 - C21.8 Malignant neoplasm of rectosigmoid junction, rectum, anus and anal canal
CPT 81275 KRAS gene analysis; variants in exon 2 (eg, codons 12 and 13) — covered if selection criteria are met
CPT 81276 additional variant(s) (eg, codon 61, codon 146) — covered if selection criteria are met

13 Active Policies

ARKBLUE-PANITUMUMAB-E-G-VECTIBIX-D635E62771, Panitumumab (e.g., Vectibix)

BCBSM-2091670-814DB5F432, VECTIBIX (PANITUMAMAB)

BCBSND-PANITUMUMAB-VECTIBIX-875C1EACB5, Panitumumab Vectibix

HEALTHNET_OR-HNOR-PANITUMUMAB-VECTIBIX-CP-PHAR-321-6D2D83714B, Panitumumab (Vectibix); CP.PHAR.321

MODA-VECTIBIX-ADE2ED4023, Vectibix (panitumumab)

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX502.061, Oncology Medications

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

BCBSOK-RX502.061, Oncology Medications

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

BCBSTN-988596f37c, Panitumumab (Vectibix)

AETNA-CPB-0748, Panitumumab (Vectibix)

BCBSIL-RX502.061, Oncology Medications

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J9303, Injection, panitumumab, 10 mg