MedicaidPrior AuthMedium impact
Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) (New)
Humana·LA · Oncology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has introduced a new prior authorization policy for Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf), a subcutaneous combination therapy for HER2-positive breast cancer. The policy establishes specific criteria for early stage, metastatic, and locally advanced breast cancer treatments with defined approval durations.
Action Required
Before February 1, 2026: Billing team must implement prior authorization requirements for Phesgo (pertuzumab, trastuzuzumab, and hyaluronidase-zzxf) for Louisiana Medicaid members. Update billing system to flag HER2-positive breast cancer patients requiring Phesgo and ensure providers document HER2-positive status, cancer staging, and specific combination therapy protocols before submitting claims. Obtain prior authorization through Humana's PA process or claims will be denied.