MedicaidPrior AuthHigh impact
Trastuzumab products (Revised)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has updated their prior authorization policy for trastuzumab cancer drugs, establishing Trazimera and Kanjinti as preferred products. Other trastuzumab products (Herceptin, Ogivri, Herzuma, Hercessi, Ontruzant) now require documented intolerance or contraindication to the preferred products before approval.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for all trastuzumab products. For Herceptin, Ogivri, Herzuma, Hercessi, and Ontruzant requests, obtain documentation of intolerance or contraindication to Trazimera or Kanjinti before submitting prior auth. Update EMR templates to include HER2 status documentation (IHC 3+ or IHC2+/ISH positive). For gastric cancer cases, ensure combination therapy with cisplatin plus fluorouracil or capecitabine is documented. Claims without proper prior authorization will be denied.