MedicaidPrior AuthMedium impact
Perjeta (pertuzumab) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Perjeta (pertuzumab) intravenous solution effective March 1, 2026, for Indiana Medicaid members with HER2-positive breast cancer. The policy requires specific diagnostic criteria and treatment combinations to be met for both early stage and metastatic breast cancer indications.
Action Required
Before March 1, 2026: Billing team must implement prior authorization requirements for Perjeta (pertuzumab) intravenous solution for Indiana Medicaid members. Providers must verify HER2-positive status (IHC 3+ or IHC 2+/ISH positive) and document specific treatment combinations as outlined in the policy. Update billing system to flag Perjeta claims for prior auth verification. Claims submitted without proper prior authorization will be denied.