MedicaidPrior AuthHigh impact
Provider Letter 2021-17: Prior Authorization of Herceptin® - Effective Jan. 17, 2022
Oklahoma SoonerCare·OK · Oncology·Prior Authorization
Effective date
Jan 17, 2022
We identified it
Jun 20, 2026
Summary
Effective January 17, 2022, Oklahoma Medicaid (SoonerCare) requires prior authorization for all Herceptin® (trastuzumab) products, with preferred biosimilar products being Ogivri®, Ontruzant®, and Trazimera™. Providers must submit form PHARM-133 to the Pharmacy Prior Authorization Unit, and should proactively submit PA requests for patients who started therapy after November 30, 2021.
Action Required
By January 17, 2022: Billing team must implement prior authorization requirements for all trastuzumab products (Herceptin®, Herzuma®, Kanjinti®, Ogivri®, Ontruzant®, and Trazimera™) for SoonerCare patients. Submit form PHARM-133 to Pharmacy Prior Authorization Unit via fax (not online portal). For patients starting therapy after November 30, 2021, proactively submit PA requests to avoid treatment disruption. Include dates of previous doses on PA forms for continuing patients. Claims will be denied without proper prior authorization.