Herceptin Drug Policy
Effective May 1, 2006 (Texas effective date: June 15, 2006).
Requires a pathology report to be submitted with the initial claim for Herceptin.
Subsequent physician claims for Herceptin for patients with previously documented HER2 overexpression will be paid without requiring a pathology report.
Failure to document HER2 gene amplification (ImmunoHistoChemistry test – IHC of 3+ or Fluorescence In Situ Hybridization test – FISH amplification of 2.1 or greater) will cause the use of Herceptin to be ineligible for reimbursement.