MedicaidPrior AuthMedium impact
Trastuzumab products (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has updated their prior authorization policy for trastuzumab products (cancer medications like Herceptin) effective January 1, 2026. The policy now requires providers to try preferred biosimilar products (Trazimera or Kanjinti) first before approving brand-name or other biosimilar versions for HER2-positive breast and gastric cancers.
Action Required
Before January 1, 2026: Oncology billing team must update prior authorization workflows to ensure Trazimera (trastuzumab-qyyp) or Kanjinti (trastuzumab-anns) are documented as first-line therapy for HER2-positive breast and gastric cancer patients. For requests of Herceptin, Ogivri, Herzuma, Hercessi, or Ontruzant, providers must document medical contraindication or intolerance to the preferred products. Update EMR templates to capture HER2 status (IHC 3+ or IHC2+/ISH positive) and treatment history.