Medicare AdvantageCoverageMedium impact
Update to Medical Benefit Drug Coverage for Medical Mutual Medicare Advantage Plans - January 2021
Medical Mutual of Ohio·Oncology, Hematology·Pharmacy
Effective date
Feb 4, 2021
We identified it
Jun 20, 2026
Summary
Medical Mutual Medicare Advantage plans updated their preferred trastuzumab products list effective February 4, 2021, adding all available biosimilar alternatives as preferred options. Members new to trastuzumab therapy must try preferred biosimilar products before non-preferred drugs can be prescribed, requiring step therapy compliance.
Action Required
Effective February 4, 2021: Providers must prescribe preferred trastuzumab biosimilars (Herzuma Q5113, Kanjinti Q5117, Ogivri Q5114, Ontruzant Q5112, or Trazimera Q5116) for new patients before prescribing non-preferred options (Herceptin J9355 or Herceptin Hylecta J9356). For existing patients or medical necessity cases, follow Medical Mutual's coverage determination process to request non-preferred drugs. Update ordering protocols and inform oncology providers of step therapy requirements.