CommercialPrior AuthMedium impact
08.02.39b, Zanidatamab-hrii (Ziihera®)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
Jun 29, 2026
We identified it
Jun 30, 2026
Summary
Policy 08.02.39b establishes new medical necessity criteria for Zanidatamab-hrii (Ziihera®), a specialty pharmaceutical agent. This is a pharmacy policy update that modifies coverage requirements effective immediately. Billing teams must understand the new medical necessity criteria to ensure claims meet coverage guidelines and avoid denials.
Action Required
By June 29, 2026: Billing and prior authorization teams must obtain and review the complete medical necessity criteria for Zanidatamab-hrii (Ziihera®) from the policy source (https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=06&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#commercial-08-02-39b). Update prior authorization submission requirements in billing system to enforce new criteria. Ensure pharmacy team and providers are notified of updated coverage requirements. Train staff on documentation needed to support medical necessity. Verify all Ziihera® claims include required documentation before submission. Failure to comply with new medical necessity criteria will result in claim denials.