MedicaidPrior AuthMedium impact
Herceptin Hylecta (trastuzumab and hyaluronidase- oysk) (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established prior authorization requirements for Herceptin Hylecta (trastuzumab and hyaluronidase-oysk) subcutaneous solution for HER2-positive breast cancer treatment. Coverage requires specific treatment protocols and prior failure/intolerance of biosimilar alternatives Kanjinti or Trazimera.
Action Required
Before March 1, 2026: Billing team must implement prior authorization process for Herceptin Hylecta prescriptions for Humana Medicaid Ohio members. Ensure providers document HER2-positive breast cancer diagnosis, specific treatment protocol (adjuvant or metastatic), and prior failure/intolerance of Kanjinti or Trazimera. Update pharmacy ordering system to flag this medication for PA requirements. Claims will be denied without proper authorization.