MedicaidPrior AuthMedium impact
Provider Letter 2022-23: Prior Authorization of Herceptin HYLECTA™ – Effective December 21, 2022
Oklahoma SoonerCare·OK · Oncology·Prior Authorization
Effective date
Dec 21, 2022
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) now requires prior authorization for Herceptin HYLECTA™ (trastuzumab/hyaluronidase-oysk) effective December 21, 2022. Patients currently on therapy can continue, but providers must use specific PA form PHARM-133 and provide clinical justification for why biosimilar alternatives cannot be used.
Action Required
By December 21, 2022: Billing team must submit prior authorization requests using form PHARM-133 for all new Herceptin HYLECTA™ prescriptions to SoonerCare members. For members who started therapy after October 1, 2022, submit PA requests immediately to avoid therapy disruption. Include dates of previous doses and clinical justification for why ONTRUZANT® or TRAZIMERA® cannot be used. Submit all requests to Pharmacy Prior Authorization Unit at fax number on PA form, not Medical Authorization Unit.