Drugs That Require Prior Authorization (PA) — HMSA Akamai Advantage (PPO)
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Lists drugs that require prior authorization under the HMSA Akamai Advantage (PPO) plan and summarizes PA criteria, required documentation, restrictions, and coverage durations for listed specialty and pharmacy drugs.
No material clinical or coverage changes in this revision.
Drug-Specific Coverage Criteria
ABIRATERONE - Initial/General Criteria
Covered when ALL of the following are met
Also allowed for salivary gland tumors if recurrent androgen receptor–positive disease
Coverage duration: Plan Year
ABRYSVO - RSV prevention
Covered when ALL of the following are met
Coverage duration: 3 months
ADEMPAS - PAH/CTEPH criteria
Covered when ALL of the following are met (PAH or CTEPH specific)
For new starts: pretreatment mean pulmonary arterial pressure >20 mmHg; pulmonary capillary wedge pressure ≤15 mmHg; pulmonary vascular resistance >2 Wood units
AIMOVIG - Migraine prevention
Covered when ALL of the following are met
Initial approval: 3 months; continuation requires ≥3 months on therapy and a reduction in migraine days per month from baseline
ALBENDAZOLE - Indication-based coverage duration
Covered when ALL of the following are met
Indications: ascariasis, trichuriasis, microsporidiosis, etc.
Alpha1-proteinase inhibitor - Eligibility
Covered when ALL of the following are met
Coverage duration: Plan Year
ALYFTREK - CF criteria
Covered when ALL of the following are met
Coverage duration: Plan Year
ARCALYST - Gout flare prevention
Covered when ALL of the following are met (gout flares prevention or recurrent pericarditis)
Continuation: demonstrated clinical benefit vs baseline; coverage duration: Plan Year
AYVAKIT - Molecular and prior therapy criteria
Covered when ALL of the following are met (selected indications)
For GIST and systemic mastocytosis other molecular or platelet criteria apply as specified
BENLYSTA - SLE and lupus nephritis criteria
Covered when ALL of the following are met
Age ≥5 years; coverage duration: Plan Year
ALVAIZ - Hematologic indications
Covered when ALL of the following are met (ITP, thrombocytopenia, severe aplastic anemia)
Continuation/response thresholds defined for ongoing dosing; coverage durations vary by indication
BENLYSTA Coverage Criteria
Covered when ALL of the following are met for respective indications
Age ≥5 years; coverage duration: Plan Year
BERINERT Coverage Criteria
Covered when ALL of the following are met for acute HAE attacks
Prescribed by or in consultation with immunologist, allergist, or rheumatologist; coverage duration: Plan Year
BIMZELX Coverage Criteria
Covered when ANY applicable criteria are met (per indication)
Applies to new starts only; coverage duration: Plan Year
Applies to new starts only
BOSULIF Coverage Criteria
Covered when ALL of the following are met for listed hematologic malignancies
Prerequisite therapy required
BOSENTAN Coverage Criteria
Covered when ALL of the following are met for PAH (WHO Group 1)
Required for all PAH agents
Applies to new starts only
Per‑drug prerequisite flags apply
Cystinosis agents (CYSTADROPS, CYSTAGON, CYSTARAN)
Covered when ALL of the following are met
Coverage duration: Plan Year
Dalfampridine (DALFAMPRIDINE ER)
Initial and continuation coverage criteria
Continuation requires improvement in walking speed or other objective measure; coverage duration: Plan Year
DAURISMO (glasdegib) for AML
Covered when ALL criteria met
Applicable in elderly or those unfit for intensive chemo per entry
Coverage duration: Plan Year
Deferasirox
Covered when ALL criteria met
Coverage duration: Plan Year
DOPTELET (avatrombopag)
Covered when ALL relevant criteria met
Age: 18+ for chronic liver disease
Age: 1+ for ITP
DUPIXENT (dupilumab)
Covered when specific disease‑specific criteria are met
Age: 6 months+; initial duration 6 months
Age: 6 years+; continuation requires improved control
Age: 1+
EMGALITY (galcanezumab)
Preventive migraine and episodic cluster headache
Initial: 3 months; continuation: Plan Year
HCV agents (EPCLUSA)
Coverage conditions follow clinical guidelines
Coverage and durations applied consistent with current AASLD‑IDSA guidance; exclusion for decompensated cirrhosis (CTP B or C) for some agents
Topiramate-containing products (EPRONTIA, TOPIRAMATE)
Coverage requires prior trials or specific conditions
Applies to epilepsy: ≥2 yrs
HCV therapy
Hepatitis C virus (HCV) treatments covered when ALL of the following are met:
Coverage/duration per AASLD‑IDSA guidance; exclude decompensated cirrhosis for some products
Topiramate — seizure and migraine indications
Covered when ANY of the following depending on indication
Age thresholds vary by indication
FASENRA — asthma and EGPA
Covered when criteria met by indication:
Continuation requires improved asthma control
Continuation requires clinical benefit
Fentanyl patch — coverage criteria
Covered when ALL of the following are met:
OR for chronic severe pain requiring extended opioid therapy: prior opioid exposure (≥30 days ER or ≥1 week IR) and monitoring for opioid use disorder; prescriber experienced in potent opioids preferred
GATTEX — short bowel syndrome
Covered when ALL of the following are met:
Continuation requires decreased parenteral support from baseline; coverage duration: Plan Year
Growth hormone (GENOTROPIN) criteria
Covered when ANY of the pediatric or adult diagnostic criteria are met:
Prescribed by or in consultation with relevant specialists
Continuation requires documented improvement
Adult GHD initial coverage criteria
Covered when ANY of the following are met
Examples: suprasellar mass with prior surgery and cranial irradiation
Biologic agents coverage criteria
Biologic agents for rheumatologic and dermatologic conditions — new starts covered when ALL applicable conditions met
Applies to new starts only
Prior therapies: phototherapy, methotrexate, cyclosporine, acitretin
HER2 agent coverage criteria
HER2-targeted oncology agents — covered when specific tumor HER2 status and treatment history/combinations are satisfied
High-risk medication coverage restrictions
High‑risk medications — restricted coverage for older adults (typically ≥65 years)
Medication considered potentially inappropriate in older adults
Applies across HRM groups
Examples: doxepin 3/6 mg or ramelteon for insomnia; levocetirizine, azelastine nasal, fluticasone nasal for rhinitis
Specific limits vary by agent
HAE prophylaxis criteria
Hereditary angioedema prophylaxis — covered when ANY of the following are met
Applies for prophylaxis indications
Alcohol withdrawal / insomnia / anticholinergic safeguards (older adults)
For alcohol withdrawal and anxiety indications and insomnia in older adults, prior‑therapy requirements apply
Applies to patients 65+
Applies to patients 65+
Applies to patients 65+
Opipza and Antipsychotics (brand) - indication-specific prior‑therapy
Covered when prior therapy criteria are met (drug‑ and indication‑specific)
Prerequisite therapy required; pathway options include inability to swallow oral formulations as alternative approval route
Coverage duration: Plan Year
OPSUMIT (macitentan) PAH criteria
Covered when ALL of the following are met for PAH (new starts)
New starts only; required right heart cath documentation
ORKAMBI
Covered when ALL of the following are met
Age restrictions apply per product; coverage duration: Plan Year
PIMECROLIMUS criteria
Covered when at least one of the following is met
Use limited to short‑term or non‑continuous chronic use; age ≥2 years for some indications
PREVYMIS CMV prophylaxis
Covered when ALL of the following are met
Age and indication‑specific restrictions apply; coverage durations noted per entry
PROCRIT initial and reauthorization criteria
Initial approval covered when ALL of the following are met
Reauthorization requires ≥12 weeks prior therapy and documented response; coverage durations vary by indication
REMICADE / RENFLEXIS criteria
Covered when ALL of the following are met for listed indications (examples shown)
Applies to new starts only; coverage duration: Plan Year
Selected drug-specific coverage criteria
Examples of selected drug‑specific coverage criteria (abbreviated)
Required tumor molecular testing documentation
PAH initial therapy criteria
Pulmonary arterial hypertension (PAH) — WHO Group 1 initial therapy
For PAH new starts: pretreatment mean PAP >20 mmHg, PCWP ≤15 mmHg, PVR >2 Wood units
BRAF mutation–dependent indications
BRAF‑targeted therapy indications — covered when the tumor shows activating BRAF mutations
Indication‑specific combinations or prior‑therapy context apply (melanoma, NSCLC, thyroid, histiocytoses, hairy cell leukemia, solid tumors)
Tasigna indication-specific criteria
Covered when ALL of the following are met (examples shown)
For GIST: disease progressed on ≥2 FDA‑approved therapies as specified
Onychomycosis criteria
Covered when ALL of the following are met
Coverage duration: 12 weeks; PA applies if cumulative therapy >90 days/year
Osteoporosis criteria (teriparatide)
Teriparatide and other parathyroid hormone analogs — covered when criteria met
AND additional risk indicators or prior injectable therapy failure/intolerance or ≥1 year oral bisphosphonate trial
Continuation requires documented benefit
Tetrabenazine initial and continuation criteria
Tetrabenazine covered when ALL of the following are met
Initial: 6 months; continuation requires demonstrated benefit
Continuation: beneficial response required
Temazepam criteria for short-term insomnia
Temazepam for short‑term insomnia (older adults) — covered when ALL of the following are met
Applies to patients 65+; cumulative use limits and PA triggers apply
IDH1-mutated disease criteria
Covered when ALL of the following are met (IDH1‑mutated disease contexts)
Indication contexts include newly‑diagnosed AML unfit for intensive chemo, post‑induction, relapsed/refractory AML, consolidation; cholangiocarcinoma subsequent therapy; select CNS tumors
Quetiapine XR/ER criteria
Quetiapine XR/ER — Initial and continuation criteria
Initial: per entry; continuation requires demonstrated benefit
Continuation requires beneficial response
Oncology targeted therapy criteria
Oncology‑targeted therapies — mutation/status and line‑of‑therapy criteria (examples)
Tumor molecular testing required per agent
Coverage under Part D may be denied if Part A/B covers administration setting
Tobramycin (inhaled) criteria
Covered when ANY of the following are met (inhaled tobramycin eligibility)
Coverage duration: Plan Year
Tremfya initiation criteria
Tremfya initiation — covered when ANY of the following are met (new starts)
Applies to new starts only; prerequisite therapy required
PAH hemodynamic criteria
PAH therapies entry criteria — required for new starts
Right heart catheterization data must be documented for initial approval
Verquvo criteria
Covered when ALL of the following are met
For initial therapy qualify if recent hospitalization for HF within 6 months OR outpatient IV diuretics within 3 months
VERZENIO — breast cancer
Covered when ALL of the following are met
Coverage duration: Plan Year
VITRAKVI — NTRK fusion-positive tumors
Covered when ALL of the following are met
Coverage duration: Plan Year; required tumor molecular testing
VOQUEZNA PAK — H. pylori
Covered when ALL of the following are met
Coverage duration: 14 days
VOSEVI — Hepatitis C Virus (HCV)
Covered when ALL of the following are met
Exclusion: decompensated cirrhosis/CTP class B or C; coverage/duration per AASLD‑IDSA guidance
XELJANZ — rheumatologic and GI indications (new starts)
Covered when ALL of the following are met (new starts)
Applies to new starts only; prerequisite therapy required
XYREM (sodium oxybate) — narcolepsy
Covered when ALL of the following are met
Prescribed by or in consultation with sleep disorder specialist or neurologist; age ≥7 for treatment
Pulmonary hypertension agents (examples: WINREVAIR, YUTREPIA)
Covered when ALL of the following are met
Coverage duration typically: Plan Year; right heart cath documentation required for new starts
ZARXIO — hematopoietic support
Covered when ALL of the following are met
Coverage duration: 6 months
Biologic for chronic spontaneous urticaria and other indications (XOLAIR example)
Covered when ALL of the following are met
Continuation requires clinical benefit; age thresholds apply by indication
YONSA — Required Condition
Covered when ALL of the following are met
Coverage duration: Plan Year
YUTREPIA — Hemodynamic confirmation for new starts
Covered when ALL of the following are met
New starts only; documentation of right heart cath required
ZEJULA — Uterine leiomyosarcoma
Covered when ALL of the following are met
Coverage duration: Plan Year
ZELBORAF — Indication-specific molecular requirements
Covered when the tumor molecular requirements are met
Coverage duration: Plan Year
ZIRABEV — Coverage note
Coverage note and Part D guidance
Coverage duration: Plan Year
ZOLINZA — Indication
Covered when ALL of the following are met
Coverage duration: Plan Year
ZONISADE — Seizure adjunctive therapy criteria
Covered when ANY of the following are met
Age ≥16 years; prerequisite therapy required; coverage duration: Plan Year
ZTALMY — Age restriction
Covered when ALL of the following are met
Coverage duration: Plan Year
ZURZUVAE — Diagnostic confirmation
Covered when ALL of the following are met
Coverage duration: 1 month
ZYDELIG — Line of therapy requirement
Covered when ALL of the following are met
Coverage duration: Plan Year
ZYKADIA — Prior therapy requirement for ALK NSCLC
Covered when ANY of the following are met
Prerequisite therapy required; coverage duration: Plan Year
ZYPREXA RELPREVV — Oral tolerability requirement
Covered when ALL of the following are met
Coverage duration: Plan Year
How to Request Prior Authorization and Required Documentation
Prior authorization required — Submit PA by phone
Prior authorization is required for drugs listed in the chart; HMSA will only provide coverage after confirming the prescription meets the specific chart criteria. Requests may be submitted by the prescriber, member, or authorized representative by calling HMSA at 1 (855) 479-3659 (TTY 711), available 24/7.
Coverage setting determination (Part A/B vs Part D)
Determine whether the medication will be covered under Medicare Part B (medical/administered) or Part D (pharmacy) by documenting the intended site of care and how the drug will be furnished; coverage under Part D will be denied if the drug is eligible for Part A or Part B coverage.
BAFIERTAM prior authorization required
BAFIERTAM requires prior authorization for all FDA‑approved indications listed under its PA group.
BIMZELX PA and step requirements
BIMZELX requires prior authorization; new starts for plaque psoriasis must document either involvement of crucial body areas or prior inadequate response/intolerance to phototherapy or systemic agents, and ankylosing spondylitis/new axial spondyloarthritis starts must document inadequate response or intolerance to an NSAID (unless contraindicated).
BOSENTAN PA — right heart cath and hemodynamics required
Bosentan (PAH) prior authorization requires confirmation of pulmonary arterial hypertension by right heart catheterization with specified pretreatment hemodynamics for new starts.
- Pretreatment mean pulmonary arterial pressure >20 mmHg
- Pulmonary capillary wedge pressure ≤15 mmHg
- Pulmonary vascular resistance >2 Wood units (adults)
BOSULIF PA — Ph chromosome and mutation testing
BOSULIF prior authorization requires diagnostic confirmation of Philadelphia chromosome/BCR-ABL and, when prior TKI resistance is claimed, documentation of mutation testing demonstrating absence of listed resistance mutations and prior intolerance/resistance to other TKIs.
- Confirm Philadelphia chromosome or BCR-ABL
- If prior TKI resistance, document negative results for specified mutations (e.g., T315I and others)
- Document prior intolerance or resistance to imatinib, dasatinib, or nilotinib as applicable
PA required for listed drugs — drug-specific documentation may be needed
Prior authorization is required for the listed drugs and generally applies to all FDA‑approved indications (and some medically‑accepted indications); many entries require drug-specific medical information, diagnostic confirmation, or prerequisite therapy.
Topiramate (EPRONTIA/TOPIRAMATE) PA with prerequisite trials
Topiramate branded products (e.g., EPRONTIA/TOPIRAMATE) require prior authorization; initiation depends on prerequisite therapy trials or documented inability to use generics, with age- and indication-specific trial requirements for seizure and migraine indications.
- Partial‑onset seizures: inadequate response/intolerance to a generic anticonvulsant required
- Monotherapy generalized seizures: trial of generic immediate‑release topiramate or swallowing impairment documented
- Migraine prevention: trial of generic immediate‑release topiramate or swallowing impairment documented
FASENRA PA — eosinophil thresholds and prior controller trials
FASENRA requires prior authorization for severe asthma and EGPA; initial starts require baseline eosinophil thresholds and prior controller therapy trials for asthma, and continuation requires demonstrated clinical benefit.
- Asthma initial: baseline blood eosinophils ≥150 cells/µL and inadequate control on medium‑to‑high‑dose ICS plus another controller
- EGPA initial: eosinophils >1000 cells/µL or >10%
Fentanyl patch PA — indication and opioid exposure documentation required
Fentanyl patch requires prior authorization with documentation that use is for cancer, sickle cell disease, terminal/palliative pain, or that the patient requires extended opioid therapy with prior opioid exposure and monitoring.
- Document cancer/sickle cell/terminal/palliative pain OR
- Document chronic severe pain requiring extended opioids with prior opioid exposure (≥30 days ER or ≥1 week IR) and opioid-monitoring plan
Requirements for New Starts
Criteria to Continue Therapy
Prerequisite Therapy and Step Requirements
| Requirement | Summary |
|---|---|
| Prerequisite therapy required | |
| Yes — many listed drugs indicate prerequisite therapy is required before approval (see individual drug entries). |
| Documentation item | What must be shown |
|---|---|
| Prior trial or contraindication to listed therapies | |
| Document prior inadequate response, intolerance, or contraindication to the specified agents (e.g., NSAIDs for ankylosing spondylitis before BIMZELX; listed anticonvulsants for seizure agents). |
| Step therapy requirement | Examples / Notes |
|---|---|
| Prior trial of specified alternatives required | |
| Many agents require documented trial and inadequate response/intolerance to specified alternatives (e.g., triptan trial before DHE Nasal; generic anticonvulsant trials before branded anticonvulsants; prior CGRP antagonist exclusion for EMGALITY). |
| Authorization prerequisite | Clinical expectation |
|---|---|
| Trial and failure/intolerance of specified alternatives required | |
| Requests require documentation of inadequate response, intolerance, or contraindication to one or more specified alternative agents prior to approval (examples include seizure, psychiatric, and oncology indications). |
| Non‑HRM / first‑line trial requirement | Examples |
|---|---|
| Trials of specified non‑HRM alternatives or first‑line therapies required | |
| For HRM neurologic and related indications, trial(s) of non‑HRM alternatives (e.g., amantadine; methotrexate or NSAIDs where applicable) must be documented before approval. Applies to older‑adult HRM groups. |
| Number of alternative agents required | Policy detail |
|---|---|
| 1–2 alternative agents required | |
| Many entries require trial of one or two specified alternatives with documentation of inadequate response or intolerance prior to approval (examples across anxiety, alcohol withdrawal, rhinitis, and biologic approvals). |
| Prior trials required (drug examples) | Specific requirement |
|---|---|
| KINERET | |
| New RA starts require inadequate response/intolerance to two listed alternative products before KINERET approval. |
| OPIPZA step therapy | Required prior trials |
|---|---|
| Trials of listed antipsychotics required | |
| OPIPZA requires documented trials (inadequate response, intolerance, or contraindication) to specified generic and brand antipsychotics or inability to swallow oral formulations before approval for several psychiatric indications. |
| Nexavar (GIST) prior therapies | Requirement |
|---|---|
| Prior therapies for GIST | |
| For GIST, prior progression on at least two FDA‑approved therapies (e.g., imatinib, sunitinib, regorafenib, ripretinib) is required before coverage of later‑line agents such as Nexavar in the GIST setting. |
| Biologic/specialty prior trial rule | Typical expectation |
|---|---|
| Trial or intolerance to first‑line/specified agents required | |
| Many biologic and specialty agents for rheumatologic, dermatologic, and other indications require prior trial and failure/intolerance to conventional first‑line therapies (e.g., methotrexate, phototherapy, NSAIDs) before new starts of biologics are authorized. |
| Prior biologic requirement | Examples |
|---|---|
| Prior failure/intolerance/contraindication to specified biologics required | |
| For several biologics (e.g., RINVOQ, SKYRIZI, STELARA), new starts require prior inadequate response, intolerance, or contraindication to at least one TNF inhibitor or other specified therapies depending on indication. |
| Documentation of prior therapy | Policy expectation |
|---|---|
| Prior ALK inhibitor trial required for ZYKADIA | |
| ZYKADIA: For ALK‑positive NSCLC, prior inadequate response/intolerance/contraindication to alectinib (Alecensa) or brigatinib (Alunbrig) is required before approval. |
| Anticonvulsant prior trials before ZONISADE | Requirement |
|---|---|
| Prior anticonvulsant trials required | |
| ZONISADE adjunctive use requires documented inadequate response, intolerance, or contraindication to a generic anticonvulsant AND to listed alternatives (Aptiom, Xcopri, Spritam) OR inability to swallow solids; age ≥16 years. |
Clinical Thresholds, Age Limits and Key Numeric Criteria
Duration and Quantity Constraints
Setting, Medicare Part A/B vs Part D and Infusion Rules
Submit site‑of‑care information (infusion vs pharmacy)
Coverage determinations may depend on the site of care; submit information about whether the medication will be administered in a medical setting (infusion/physician office) versus dispensed from a pharmacy because Part A/B versus Part D coverage may differ.
- If the medication is furnished incident to a physician service or in an outpatient infusion center, Part A/B coverage may apply
BERINERT prescriber and documentation requirement
BERINERT should be prescribed by or in consultation with an immunologist, allergist, or rheumatologist and prior authorization documentation for HAE must include laboratory confirmation or genetic/family history as specified.
- HAE diagnosis confirmation by lab testing (C1 inhibitor deficiency/dysfunction) or genetic testing/family history and antihistamine‑refractory course for HAE with normal C1
Part D denial when Part A/B coverage applies
Coverage under Part D will be denied if the medication is appropriately covered under Medicare Part A or Part B based on how it is prescribed, dispensed, or administered for the individual.
Part A/B coverage conflict may trigger denial
Coverage under Part D will be denied if coverage is available under Part A or Part B for the medication as prescribed and administered for the individual; providers should confirm the appropriate benefit and submit setting information.
Denial Triggers, Interactions, and Documentation Risks
Denial triggers: interactions and unmet prerequisite therapy
Coverage will be denied when the requested drug is used in conjunction with potent CYP3A4 inhibitors or when prerequisite therapy requirements (e.g., required trials of specified alternatives) are not met.
- Examples: ergotamine or DHE nasal used with potent CYP3A4 inhibitors will be denied
- Failure to document required prerequisite trials where listed may result in denial
Ergotamine + potent CYP3A4 inhibitor → denial
Coverage will be denied if ergotamine (or related agents) is used concomitantly with potent CYP3A4 inhibitors such as ritonavir, nelfinavir, indinavir, erythromycin, or clarithromycin.
Part D denial risk when Part A/B covers
If a medication is properly payable under Medicare Part A or Part B given how it is administered, a Part D coverage request will be denied; submit setting and administration details so HMSA can determine the correct benefit.
Denial risk if mutation/diagnostic confirmation missing
Failure to provide required diagnostic confirmation (for example, tumor mutation testing such as RET, FLT3, BRAF) or other specified documentation may result in denial for oncology and targeted therapy requests.
- Document mutation status (e.g., BRAF V600E, FLT3‑ITD, RET fusion) when required by the drug entry
Ivermectin for COVID‑19 excluded
Ivermectin tablets requested for prevention or treatment of COVID‑19 are not covered; prior authorization requests must confirm the indication is an FDA‑listed parasitic condition.
Repeated Part A/B vs Part D denial risk
Part D coverage will be denied when the medication is appropriately covered under Part A or Part B based on how it is prescribed, dispensed, or administered (examples reiterated across oncology and specialty drug entries).
Policy Background and Scope
This document provides HMSA’s drug prior authorization (PA) requirements for the listed pharmacy and specialty medications. It specifies individualized PA criteria tied to diagnoses (for example, PAH, HCV, CLL, cystic fibrosis), required diagnostic confirmations (eg, right heart catheterization hemodynamics for PAH; HCV RNA for hepatitis C; genetic/enzyme testing for rare diseases), prior treatment failures or intolerances or contraindications (step‑therapy prerequisites), and, where applicable, administration or setting constraints (for example, whether the drug is furnished in a medical infusion setting that may affect Medicare Part A/B vs Part D coverage). The charted entries indicate initial and continuation rules, objective thresholds (labs, hemodynamics, age limits), required documentation to support the request, and typical coverage durations (commonly Plan Year unless a shorter course is specified).
Prior authorization is required for the drugs listed in the chart. Prescribers, the member, or an authorized representative must request PA by calling HMSA at 1 (855) 479-3659 (TTY 711); the number is available 24/7. Requests are reviewed to confirm the prescription meets the drug‑specific criteria in the chart, including required diagnostic data, prior therapy history, lab or mutation results, and site‑of‑care information where applicable. Failure to meet the specified criteria or to provide required documentation may lead to denial of coverage.
Key Clinical Definitions and Terms
Biosimilar Switching and Safety Notes
Biosimilar switch: intolerable adverse event to Trazimera required
For trastuzumab biosimilar switches (Ontruzant/Ogivri references), patients must have had an intolerable adverse event to Trazimera not attributed to the active ingredient per the biosimilar preference notes.
- Document intolerable adverse event to Trazimera with rationale that it was not due to the active ingredient
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