Medical benefit coverage changes for Ontruzant and Kanjinti start August 1

Beginning Aug. 1, 2024, we’ll cover Ontruzant® under the medical benefit without prior authorization requirements and will remove Kanjinti® from coverage for commercial group and individual members. For Medicare Advantage members, Kanjinti will now require prior authorization, which includes trials of both Ontruzant and Trazimera.

This only impacts members who haven’t previously been administered Kanjinti. Commercial group, independent and Medicare Advantage members currently receiving treatment with Kanjinti will remain covered.

What do they treat?

Ontruzant and Kanjinti are Herceptin (trastuzumab) biosimilars used to treat certain types of cancers that test positive for the protein human epidermal growth factor receptor 2 (HER2). These cancers include breast cancer, gastric cancer, and esophagogastric cancer.

How will this impact you?

• Ontruzant: You won’t be required to obtain prior authorization when prescribing Ontruzant.
• Kanjinti: If you’d like your patient to start treatment with Kanjinti, you’ll need to obtain prior authorization from Priority Health.

What are covered alternatives for Kanjinti?

Covered alternatives for Kanjinti include:

• Ontruzant (beginning August 1)
• Trazimera

Have questions?

Call us toll-free at: 800.466.6642 We’re available 8 a.m. to 7 p.m., Monday – Friday and from 8:30 a.m. to 12 p.m. on Saturday.