MedicaidPrior AuthMedium impact
Perjeta (pertuzumab) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Perjeta (pertuzumab), an IV cancer medication used for HER2-positive breast cancer treatment. This affects both early stage and metastatic breast cancer patients requiring specific combination therapies and HER2 testing documentation.
Action Required
Before March 1, 2026: Billing team must update prior authorization workflows to require approval for Perjeta (pertuzumab) for Ohio Medicaid patients. Providers must document HER2-positive status (IHC 3+ or IHC 2+/ISH positive), specific combination therapy regimens, and ensure treatment duration does not exceed 52 weeks or 18 cycles for early stage cases. Claims will be denied without proper prior authorization.