All PlansPrior AuthMedium impact
Trastuzumab Products: Trastuzumab (Herceptin®); Trastuzumab-dttb (Ontruzant®); Trastuzumabpkrb (Herzuma®); Trastuzumab-dkst (Ogivri®); Trastuzumab-qyyp (Trazimera™); Trastuzumabanns (Kanjinti™); Trastuzumab-strf (Hercessi™)
BCBS Tennessee·Oncology, Hematology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
New medical policy for Trastuzumab products (Herceptin and biosimilars) establishes comprehensive coverage criteria for various HER2-positive cancers including breast, gastric, colorectal, and other tumor types. The policy requires prior authorization with specific documentation of HER2 status and mutation testing, and includes detailed quantity limits and dosing regimens.
Action Required
Before June 30, 2026: Billing team must implement prior authorization requirements for all Trastuzumab products (Herceptin, Ontruzant, Herzuma, Ogivri, Trazimera, Kanjinti, Hercessi). Update system to capture required documentation: HER2 status, RAS mutation status, and BRAF mutation status where applicable. Review step therapy requirements document at provided URL. Ensure providers document specific coverage criteria for each indication before submitting claims.