Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Zenocutuzumab-zbco (Bizengri) may be considered medically necessary for
ANY
of the following conditions:
Non-Small Cell Lung Cancer (NSCLC)
-
Treatment of individuals 18 years of age or older with advanced, unresectable or metastatic NSCLC with a neuregulin 1 (NRG1) gene fusion who has experienced disease progression on or after prior systemic therapy;
or
Pancreatic Cancer
-
Treatment of individuals 18 years of age or older with advanced, unresectable or metastatic pancreatic adenocarcinoma with a neuregulin 1 (NRG1) gene fusion who has experienced disease progression on or after prior systemic therapy;
or
Compendia Sources
Zenocutuzumab-zbco (Bizengri) may be considered medically necessary for treatment of any of the current category 1, 2A, or 2B NCCN recommendations
The use of zenocutuzumab-zbco (Bizengri) for all other indications not listed in this policy is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness cannot be established by the available published peer-reviewed literature.
Procedure Codes
