MedicaidPrior AuthMedium impact
Trastuzumab products (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has revised their prior authorization policy for trastuzumab products (cancer treatment drugs like Herceptin) effective January 1, 2026. The policy establishes Trazimera and Kanjinti as preferred first-line options, requiring documented intolerance or contraindication before approving other trastuzumab biosimilars for HER2-positive breast or gastric cancers.
Action Required
By January 1, 2026: Oncology billing team must update prior authorization procedures for all trastuzumab products (Herceptin, Kanjinti, Ogivri, Trazimera, Ontruzant, Herzuma, Hercessi). Ensure providers document HER2-positive status (IHC 3+ or IHC2+/ISH positive) and trial of preferred agents (Trazimera or Kanjinti) before requesting other biosimilars. Update EMR templates to capture required clinical criteria including combination therapy details for gastric cancer cases.