Loading...Loading...Part D medications
Effective January 1, 2026, OncoHealth will begin managing the pre-authorization reviews for oncology medications that require pre-authorization under the Part D benefit.
Part B medications
Effective January 1, 2026, the medications and codes listed in the two tables below will require pre-authorization review by OncoHealth for Medicare Part B under our Medicare Part B Oncology Review, dru-m003, medication policy.
HCPCS Code | Product |
|---|---|
A9607 | Pluvicto (lutetium Lu 177 vipivotide tetraxetan) |
J0870 | Rytelo (imetelstat) |
J1323 | Elrexfio (elranatamab) |
J1326 | Vyloy (zolbetuximab) |
J1448 | Cosela (trilacicilib) |
J3055 | Talvey (talquetamab) |
J3263 | Loqtorzi (toripalimab) |
J9022 | Tecentriq (atezolizumab) |
J9023 | Bavencio (avelumab) |
J9024 | Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs) |
J9026 | Imdelltra (tarlatamab) |
J9028 | Anktiva (nogapendekin alfa inbakicept) |
J9029 | Adstiladrin (nadofaragene firadenovec) |
J9039 | Blincyto (blinatumomab) |
J9042 | Adcetris (brentuximab vedotin) |
J9047 | Kyprolis (carfilzomib) |
J9061 | Rybrevant (amivantamab) |
J9063 | Elahere (mirvetuximab soravtansine) |
J9119 | Libtayo (cemiplimab) |
J9144 | Darzalex Faspro (daratumumab and hyaluronidase-fihj) |
J9145 | Darzalex (daratumumab) |
J9153 | Vyxeos (daunorubicin liposomal and cytarabine liposomal) |
J9173 | Imfinzi (durvalumab) |
J9176 | Empliciti (elotuzumab) |
J9177 | Padcev (enfortumab) |
J9198 | Infugem (gemcitabine) |
J9223 | Zepzelca (lurbinectedin) |
J9227 | Sarclisa (isatuximab) |
J9228 | Yervoy (ipilimumab) |
J9229 | Besponsa (inotuzumab ozogamicin) |
J9271 | Keytruda (pembrolizumab) |
J9272 | Jemperli (dostarlimab) |
J9273 | Tivdak (tisotumab) |
J9274 | Kimmtrak (tebentafusp) |
J9286 | Columvi (glofitamab) |
J9289 | Opdivo Qvantig (nivolumab and hyaluronidase) |
J9298 | Opdualag (nivolumab / relatlimab) |
J9299 | Opdivo (nivolumab) |
J9301 | Gazyva (obinutuzumab) |
J9304 | Pemfexy (pemetrexed) |
J9306 | Perjeta (pertuzumab) |
J9308 | Cyramza (ramucirumab) |
J9309 | Polivy (polatuzumab vedotin) |
J9316 | Phesgo (pertuzumab and trastuzumab and hyaluronidase-zzxf) |
J9317 | Trodelvy (sacituzumab) |
J9321 | Epkinly (epcoritamab) |
J9324 | Pemrydi RTU (pemetrexed) |
J9325 | Imlygic (talimogene laherparepvec) |
J9329 | Tevimbra (tislelizumab) |
J9345 | Zynyz (retifanlimab) |
J9347 | Imjudo (tremelimumab) |
J9349 | Monjuvi (tafasitamab) |
J9350 | Lunsumio (mosunetuzumab) |
J9352 | Yondelis (trabectedin) |
J9353 | Margenza (margetuximab) |
J9354 | KADCYLA (ado-trastuzumab emtansine) |
J9358 | Enhertu (fam-trastuzumab deruxtecan-nxki) |
J9380 | Tecvayli (teclistamab) |
Q2043 | Provenge (sipuleucel-T) |
Q5122 | Nyvepria (pegfilgrastim-apgf) |
Q5136 | Wyost (denosumab-bbdz) |
Q5136 | Jubbonti (denosumab-bbdz) |
Q5159 | Xbryk (denosumab-dssb) |
Q5159 | Opsomyv (denosumab-dssb) |
HCPCS not yet assigned | Jobevne (bevacizumab-nwgd) |
HCPCS not yet assigned | Datroway (datopotamab deruxtecan) |
HCPCS not yet assigned | Stobcolo (denosumab-bmwo) |
HCPCS not yet assigned | Osenvelt (denosumab-bmwo) |
HCPCS not yet assigned | Conexxence (denosumab-bnht) |
HCPCS not yet assigned | Bomyntra (denosumab-bnht) |
HCPCS not yet assigned | Caelyx (doxorubicin hydrochloride liposome) |
HCPCS not yet assigned | Avgemsi (gemcitabine) |
HCPCS not yet assigned | Amtagvi (lifileucel) |
HCPCS not yet assigned | Penpulimab (penpulimab-kcqx) |
HCPCS Code | Product |
|---|---|
Q2057 | Tecelra (afamitresgene autoleucel) |
J9264 | Abraxane (albumin bound paclitaxel) |
Q2041 | Yescarta (axicabtagene ciloleucel) |
J9035 | Avastin (bevacizumab) |
Q5129 | Vegzelma (bevacizumab-adcd) |
Q5126 | Alymsys (bevacizumab-maly) |
HCPCS not yet assigned | Avzivi (bevacizumab-tnjn) |
Q2053 | Tecartus (brexucabtagene autoleucel) |
Q2056 | Carvykti (ciltacabtagene autoleucel) |
J0897 | Xgeva (denosumab) |
J0897 | Prolia (denosumab) |
Q2049 | LipoDox (doxorubicin hydrochloride liposome) |
Q2050 | Doxil (doxorubicin hydrochloride liposome) |
J9361 | Ryzneuta (Efbemalenograstim Alfa) |
J1449 | Rolvedon (eflapegrastim) |
Q2055 | Abecma (idecabtagene vicleucel) |
J9205 | Onivyde (irinotecan hydrochloride liposome) |
Q2054 | Breyanzi (lisocabtagene maraleucel) |
Q2058 | Aucatzyl (obecabtagene autoleucel) |
J2506 | Neulasta (pegfilgrastim) |
Q5120 | Ziextenzo (pegfilgrastim-bmez) |
Q5111 | Udenyca (pegfilgrastim-cbqv) |
Q5127 | Stimufend (pegfilgrastim-fpgk) |
J9312 | Rituxan (rituximab) |
J9311 | Rituxan Hycela (rituximab and hyaluronidase) |
J9331 | Fyarro (Sirolimus) |
Q2042 | Kymriah (tisagenlecleucel) |
J9355 | Herceptin (trastuzumab) |
J9356 | Herceptin Hylecta (trastuzumab and hyaluronidase) |
Q5114 | Ogivri (trastuzumab-dkst) |
Q5113 | Herzuma (trastuzumab-pkrb) |
Q5146 | Hercessi (trastuzumab-strf) |