Does J9305 require prior authorization?

Yes, J9305 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9305?

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

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`J9305`, Injection, pemetrexed, not otherwise specified, 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

The indications below including FDA-approved indications and compendial uses are considered a covered benefit provided that all the approval criteria are met and the member has no exclusions to the prescribed therapy.

Key Coverage Criteria

Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
The indications below including FDA-approved indications and compendial uses are considered a covered benefit provided that all the approval criteria are met and the member has no exclusions to the prescribed therapy.
Authorization of 6 months may be granted for treatment of non-squamous non-small cell lung cancer (including leptomeningeal metastases).
Authorization of 6 months may be granted for treatment of persistent or recurrent epithelial ovarian cancer, fallopian tube cancer, primary peritoneal cancer, carcinosarcoma (malignant mixed Müllerian tumors), clear cell carcinoma of the ovary, grade 1 endometrioid carcinoma, low-grade serous carcinoma/ovarian borderline epithelial tumor (low malignant potential), or mucinous carcinoma of the ovary, as single agent therapy.
Authorization of 6 months may be granted for treatment of primary CNS lymphoma, as a single agent.
Disease is unresectable or metastatic.

14 Active Policies

ARKBLUE-PEMETREXED-E-G-ALIMTA-04AC8BAFFA, Pemetrexed (e.g., Alimta)

BCBSNJ-DRUGS-083-DCE695AF19, Pemetrexed Disodium (Alimta)

MODA-PEMETREXED-DA8B442892, Pemetrexed: Alimta; Pemfexy; Pemrydi RTU; Axtle; Pemetrexed Ψ

HEALTHNET_OR-HNOR-PEMETREXED-ALIMTA-PEMFEXY-AXTLE-CP-PHAR-368-DB90E94DEE, Pemetrexed (Alimta, Pemfexy, Axtle); CP.PHAR.368

IBX-COMMERCIAL-08-00-87P-3A31A18E5E, Pemetrexed (Pemfexy)

IBX-MEDICARE-ADVANTAGE-MA08-047N-C3B61A3B79, Pemetrexed (Pemfexy)

UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

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

SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

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

AMERIHEALTH-COMMERCIAL-08-00-87P-48892DE25D, Pemetrexed (Pemfexy)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-047N-86661D10F9, Pemetrexed (Pemfexy)

BCBSTN-88b429e286, Pemetrexed (Alimta; Pemfexy, Pemetrexed, Pemrydi RTU, Axtle)

UHC-POL-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

`J9305`, Injection, pemetrexed, not otherwise specified, 10 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

J9305, Injection, pemetrexed, not otherwise specified, 10 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

14 Active Policies

Related Codes

Have a follow-up question?

`J9305`, Injection, pemetrexed, not otherwise specified, 10 mg