CommercialPrior AuthMedium impact
Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta™)
BCBS Tennessee·TN · Oncology, Hematology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
BlueCross BlueShield of Tennessee is implementing a new medical policy for Herceptin Hylecta (trastuzumab and hyaluronidase-oysk) for HER2-positive breast cancer treatment, requiring step therapy and prior authorization with specific coverage criteria. The policy covers FDA-approved indications and compendial uses with up to 12-month authorizations and specific dosing limits.
Action Required
Before June 30, 2026: Billing team must update prior authorization procedures for Herceptin Hylecta claims to include HER2 status documentation and step therapy requirements. Review the step therapy guide at bcbst.com and update billing system to flag cases requiring 12-month authorization limits. Ensure providers document HER2-positive status for all breast cancer patients receiving this medication.