Panitumumab (Vectibix) (CPB 0748, reviewed 2025-12-23)

By 2025-12-23, the billing and prior authorization teams must implement the following: (1) Update Aetna prior authorization workflows to REQUIRE precertification for ALL panitumumab requests via phone (866) 752-7021 or fax (888) 267-3277; (2) Modify authorization protocols to mandate RAS mutation testing (KRAS and NRAS wild-type) documentation before approval; (3) For BRAF V600E positive tumors, require encorafenib (Braftovi) combination therapy documentation; (4) For KRAS G12C mutations, require sotorasib (Lumakras) or adagrasib (Krazati) combination therapy AND prior chemotherapy documentation; (5) For first-line colon cancer (ICD-10: C18.0-C18.9), enforce LEFT-SIDED TUMOR ONLY restriction in authorization system; (6) Configure denial rules for all non-covered indications (esophageal, gastric, breast, pancreatic, lung, bladder, ovarian cancers, etc.) listed in the policy; (7) Update billing software to require molecular testing CPT codes (81275, 81276, 81311, 81210) documentation with all panitumumab claims; (8) Train providers and authorization staff on new combination therapy requirements; (9) Flag and deny any panitumumab claims for appendiceal or anal adenocarcinoma without prior authorization. Failure to implement precertification will result in claim denials. Claims lacking required mutation testing documentation will be rejected.