MedicaidPrior AuthMedium impact
Perjeta (pertuzumab) (New)
Humana·LA · Oncology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid is implementing a new prior authorization policy for Perjeta (pertuzumab) effective March 1, 2026, covering treatment of HER2-positive breast cancer in early stage and metastatic cases. This policy establishes specific approval criteria including cancer staging, HER2 status requirements, and combination therapy protocols.
Action Required
Before March 1, 2026: Billing team must update prior authorization workflow to require approval for all Perjeta (pertuzumab) claims for Louisiana Medicaid patients. Providers must document HER2-positive status (IHC 3+ or IHC 2+/ISH positive), specific breast cancer diagnosis (early stage or metastatic), and planned combination therapy regimen. Update encounter forms to capture required clinical criteria. Claims will be denied without prior authorization approval.