J9292 Inj, pemetrexed dipotassiumInjection, pemetrexed dipotassium, 10 mg
J9292 payment limit: $76.69 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
83831-0131-01 Axtle, Avyxa Pharma, LLC: 10 billing units per package (1 VIAL in 1 CARTON / 4 mL in 1 VIAL)83831-0132-01 Axtle, Avyxa Pharma, LLC: 50 billing units per package (1 VIAL in 1 CARTON / 20 mL in 1 VIAL)Status E: excluded from the PFS by regulation.
45 of 45 payer prior-auth lists that name J9292 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California Promise Health Plan, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Texas, Molina Healthcare of Utah, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | Other groups: AZ Blue | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | eviCore-delegated groups | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth required | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) | |
| Blue Shield of California Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| Aetna | Commercial | All | prior auth required | Jul 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Medicare Advantage | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Medicare Advantage | All | prior auth required | Step therapy applies | Aug 25, 2026 | Aetna Medicare Part B drug list (partbname.xml) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2025 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2025 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2025 | Master Precertification List (For Health Care Providers) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| CarePlus Health Plans | CarePlus Health Plans | FL | prior auth required | NDC required | Jan 1, 2027 | Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List We have updated our CarePlus Health Plans Prior Authorization and Notification List for CarePlus Medi |
| Humana | Humana D-SNP (FL) | FL | prior auth required | NDC required | Jul 1, 2026 | H1036-280 Humana Fully Integrated Florida prior authorization and notification list |
| Humana | Humana D-SNP (IL) | IL | prior auth required | NDC required | Jan 1, 2027 | Humana Dual Fully Integrated Illinois prior authorization and notification list |
| Humana | Humana D-SNP (IN) | IN | prior auth required | NDC required | Jan 1, 2027 | Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes: |
| Humana | Humana D-SNP (MI) | MI | prior auth required | NDC required | Oct 14, 2026 | Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL) |
| Humana | Humana D-SNP (SC) | SC | prior auth required | NDC required | Jul 1, 2026 | Humana Dual Integrated South Carolina prior authorization and notification list |
| Humana | Humana D-SNP (VA) | VA | prior auth required | NDC required | Jul 1, 2026 | Prior authorization and notification list Humana Dual Fully Integrated H2875-001 (Virginia) Humana Dual Fully Integrated H2875-003 (Virginia) |
| Humana | Humana Healthy Horizons | KY | prior auth required | NDC required | Oct 7, 2026 | Humana Healthy Horizons in Kentucky Prior Authorization and Notification List |
| Humana | Humana Healthy Horizons | LA | prior auth required | NDC required | Oct 14, 2026 | Humana Healthy Horizons in Louisiana Prior Authorization and Notification List |
| Humana | Humana Healthy Horizons | OH | prior auth required | NDC required | Oct 14, 2026 | Humana Healthy Horizons in Ohio prior authorization and notification List |
| Humana | Humana Healthy Horizons | OK | prior auth required | NDC required | Oct 14, 2026 | Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List |
| Humana | Humana Healthy Horizons | SC | prior auth required | NDC required | Oct 14, 2026 | Humana Healthy Horizons in South Carolina prior authorization and notification list |
| Humana | Humana Healthy Horizons | VA | prior auth required | NDC required | Oct 14, 2026 | Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list |
| Humana | Humana MA and D-SNP | All | prior auth required | NDC required | Jan 1, 2027 | Medicare Advantage and Dual Eligible Special Needs Plans prior authorization and notification list Important notes: |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2025 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Jan 1, 2025 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | cancer dx via Evolent | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| Surest | Surest health plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Texas CHIP | TX | prior auth under conditions | site of care: outpatient | Jan 1, 2026 | Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Hawaii (QUEST Integration) | HI | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth under conditions | site of care: outpatient | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
J9292 appears in 27 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Centene, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Antiemetic Therapy (0724) | listed, no stance | Jul 17, 2026 | payer document |
| Aetna | Bevacizumab for Non-Ocular Indications (0685) | listed, no stance | Apr 7, 2026 | payer document |
| Aetna | Dostarlimab-gxly (Jemperli) (0993) | listed, no stance | Jan 27, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Hodgkin's Disease (0495) | listed, no stance (range J9000-J9999) | Jul 2, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Multiple Myeloma (0497) | listed, no stance (range J9000-J9999) | Aug 5, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496) | listed, no stance (range J9000-J9999) | Aug 6, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626) | listed, no stance (range J9000-J9999) | Sep 18, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met (range J9000-J9999) | Mar 31, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J9000-J9999) | Mar 5, 2026 | payer document |
| Aetna | Margetuximab-cmkb (Margenza) (0985) | listed, no stance (range J9000-J9999) | May 27, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | listed, no stance (range J9000-J9999) | Jun 8, 2026 | payer document |
| Aetna | Pembrolizumab Products (Keytruda and Keytruda Qlex) (0890) | listed, no stance | Jul 14, 2026 | payer document |
| Aetna | Pemetrexed Products (0687) | covered if criteria are met | Jul 17, 2026 | payer document |
| Aetna | Pertuzumab Products (0973) | listed, no stance (range J9000-J9999) | Apr 27, 2026 | payer document |
| Aetna | Phototherapy and Photochemotherapy (PUVA) for Skin Conditions (0205) | listed, no stance (range J9000-J9999) | May 18, 2026 | payer document |
| Aetna | Revakinagene Taroretcel-lwey (Encelto) (1079) | listed, no stance (range J8501-J9999) | Oct 5, 2026 | payer document |
| Aetna | Tumor Chemoresistance Assays (0758) | listed, no stance (range J9000-J9999) | Dec 2, 2025 | payer document |
| Aetna | Tumor Chemosensitivity Assays (0245) | listed, no stance (range J9000-J9999) | Apr 13, 2026 | payer document |
| Aetna | Vitamin B-12 Therapy (0536) | listed, no stance | Aug 20, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Breast Cancer (CAM 80127) | listed, no stance (range J9000-J9999) | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (CAM 80124) | unproven / investigational (range J9000-J9999) | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117) | listed, no stance (range J9000-J9999) | Jan 1, 2026 | payer document |
| Centene | Pemetrexed (Alimta, Pemfexy, Axtle) (CP.PHAR.368) | covered if criteria are met | Feb 1, 2026 | payer document |
| Premera Blue Cross | Folate Antimetabolites (5.01.617) | listed, no stance | Apr 14, 2026 | payer document |
| UnitedHealthcare | Medicare Part B Step Therapy Programs (IAP.001.30) Non-Preferred | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Oncology Medication Clinical Coverage (CS2026D0030AR) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Oncology Medication Clinical Coverage (for Pennsylvania Only) (CSPA2026D0030II) | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in IN, MS, VA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.