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CommercialCoverageMedium impact

08.00.33t, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

Independence Blue Cross·Oncology·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Days to comply
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Summary

The trastuzumab (Herceptin) policy has been updated with changes to medical necessity criteria and medical coding requirements. This affects billing for breast cancer treatment with Herceptin and its biosimilar versions including Herceptin Hylecta.

Action Required

Action needed
By June 16, 2025: Review updated medical necessity criteria for trastuzumab (Herceptin) and biosimilars. Oncology providers must ensure documentation meets new requirements before prescribing. Billing team should verify any coding changes in the full policy document at the provided URL and update billing software accordingly.

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