MedicaidPrior AuthMedium impact
Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana is implementing a new prior authorization policy for Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf), a subcutaneous breast cancer treatment. The policy establishes specific coverage criteria for early stage, locally advanced, and metastatic HER2-positive breast cancer with detailed approval requirements and treatment duration limits.
Action Required
Before February 1, 2026: Billing team must update prior authorization workflows for Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) subcutaneous solution for Humana Medicaid Indiana members. Providers must document HER2-positive breast cancer diagnosis, specific treatment combinations, and ensure treatment does not exceed 52 weeks or 18 cycles for early stage cases. Visit www.humana.com/PAL for specific medical billing codes and preauthorization requirements.