Effective March 21, 2022, Independence 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.
Commercial and Medicare Advantage Policy Notifications were posted December 21, 2021:
- #08.01.72a: Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
- #MA08.129a: Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)