Effective March 21, 2022, AmeriHealth will update the coverage criteria for Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo^®). The changes include the addition of left ventricular ejection fraction result requirements prior to the initiation of the drug.

• Left ventricular ejection fraction (LVEF) greater than 55 percent for early-stage breast cancer
• Left ventricular ejection fraction (LVEF) greater than 50 percent for later-stage breast cancer

These changes align with the U.S. Food and Drug Administration label dosing guidelines.

A Policy Notification for #08.01.72a: Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo^®) was posted December 21, 2021.