Trazimera to be preferred trastuzumab product for Medicare Advantage members, starting May 12

Preferred and nonpreferred trastuzumab products are changing for Medicare Plus Blue℠ and BCN Advantage℠ members for dates of service on or after May 12, 2025.

The preferred trastuzumab product will be Trazimera^® (trastuzumab-qyyp), HCPCS code Q5116.

Health care providers will have to show that our Medicare Advantage members have tried and failed Trazimera when requesting prior authorization for the following nonpreferred drugs:

• Herceptin^® (trastuzumab), HCPCS code J9355
• Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk), HCPCS code J9356
• Ontruzant^® (trastuzumab-dttb), HCPCS code Q5112
• Herzuma^® (trastuzumab-pkrb), HCPCS code Q5113
• Ogivri^® (trastuzumab-dkst), HCPCS code Q5114
• Kanjinti^® (trastuzumab-anns), HCPCS code Q5117

Trazimera will continue to require prior authorization.

Submit prior authorization requests to OncoHealth when these drugs will be billed as a medical benefit.

When prior authorization is required

These drugs require prior authorization, as applicable, when they are administered by a health care provider in sites of care such as outpatient facilities or physician offices and are billed in one of the following ways:

• Electronically through an 837P transaction or on a professional CMS-1500 claim
• Electronically through an 837I transaction or using the UB04 claim for a hospital outpatient type of bill 013X

How to submit prior authorization requests

Submit prior authorization requests to OncoHealth using one of the following methods:

• Through the OncoHealth OneUM™ portal, which you can access by logging in to our provider portal at availity.com,** clicking on Payer Spaces, and then clicking on the BCBSM and BCN logo. Click on the OncoHealth Provider Portal tile in the Applications tab.
• By calling OncoHealth at 1-888-916-2616
• By faxing to OncoHealth at 1-800-264-6128

List of requirements

For a list of requirements related to drugs covered under medical benefits, see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members.

We’ll update this list prior to the effective date.

***Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.