CommercialCoverageMedium impact
08.00.33v, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
This policy update modifies coverage and/or reimbursement positions for Trastuzumab (Herceptin®) and related biosimilars, as well as Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta). The changes affect how these cancer medications will be covered or reimbursed starting January 1, 2026.
Action Required
By December 31, 2025: Billing team must review the full policy document at the provided URL to understand specific coverage and reimbursement changes for Trastuzumab (Herceptin®) biosimilars and Herceptin Hylecta. Update billing procedures, prior authorization requirements, and fee schedules as specified in the detailed policy. Coordinate with oncology providers to ensure compliance with new coverage criteria.