CommercialCoverageMedium impact
Pharmacy coverage changes
Harvard Pilgrim Health Care·Oncology, Pharmacy·Pharmacy
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health updated coverage criteria for Hernexeos (a HER2 cancer medication) effective June 1, 2026. The new policy requires documentation that the patient has not experienced disease progression on another HER2 tyrosine kinase inhibitor before approving Hernexeos coverage.
Action Required
Before June 1, 2026: Oncology providers must document in patient records that patients have not experienced disease progression on another HER2 tyrosine kinase inhibitor (TKI) when prescribing Hernexeos. Update EMR templates and prior authorization forms to include this requirement. Billing team should verify this documentation is complete before submitting Hernexeos claims to avoid denials.