All PlansCoverageMedium impact
08.02.39, Zanidatamab-hrii (Ziihera®)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Apr 21, 2025
We identified it
Jun 19, 2026
Summary
This is a new pharmacy policy for Zanidatamab-hrii (Ziihera®), a bispecific antibody therapeutic agent. The policy establishes coverage guidelines, likely including prior authorization requirements, medical necessity criteria, and billing procedures for this newly approved medication. Billing teams must implement this policy immediately to ensure proper claim processing and avoid denials.
Action Required
By April 21, 2025: Billing team must obtain and review the complete policy text from the provided URL to identify specific HCPCS codes for Zanidatamab-hrii. Determine prior authorization requirements, medical necessity documentation needs, and any coverage restrictions. Update billing system with new codes and prior auth rules. Notify providers and clinical staff of coverage criteria and required documentation. Train front desk and billing staff on authorization procedures. Verify policy details directly with payer to confirm all requirements before processing claims for this medication.