Humana Medicare Advantage swaps its preferred trastuzumab
Kanjinti and Ogivri traded places in September. For new starts the preferred choices are Ogivri and Trazimera; some patients already on Kanjinti are exempt from the step.
The short version
For Humana Medicare Advantage patients starting trastuzumab, the preferred products are Ogivri and Trazimera. Kanjinti is now non-preferred. Humana exempts patients from the step therapy requirement only if they are already actively receiving the non-preferred drug and have a paid claim for it within the past year.
What changed
By its September 2, 2026 revision, Humana's Medicare Part B step therapy list had swapped two trastuzumab biosimilars:
- Ogivri (Q5114) moved from non-preferred to preferred. It joins Trazimera (Q5116), which stays preferred.
- Kanjinti (Q5117) moved from preferred to non-preferred.
Herceptin, Herceptin Hylecta, Hercessi, Herzuma and Ontruzant remain non-preferred. The current edition of the list, revised October 21, keeps the same trastuzumab designations.
Who it affects
Humana states that the step therapy requirement does not apply to patients who are already actively receiving treatment with a non-preferred drug and have a paid claim for it within the past year. Both conditions have to hold. New starts don't qualify, and neither does a patient who has stopped Kanjinti, even if their last claim was recent. For anyone outside the exemption, a Kanjinti request goes through Humana's step therapy requirement, whose details are in Humana's coverage policies.
Humana also notes that preferred status alone does not guarantee an exemption from step therapy, so check the drug's coverage policy even when ordering Ogivri or Trazimera.
Why it is easy to miss
Kanjinti's code and name are unchanged; only its column moved. And Humana revises this list often: twice in September, on the 2nd and the 16th, and twice again in October. A copy saved at the start of a month can be out of date by the middle of it.
What to do
- Review new-start order sets for Humana Medicare Advantage so they default to Ogivri or Trazimera.
- For each established Kanjinti patient, confirm they are actively on therapy and have a paid claim in the past year before assuming the exemption applies.
- If a patient has a reason to need Kanjinti, Humana offers an expedited exception review and an appeal.
Source: Humana, Medicare Part B step therapy preferred drug list (effective January 1, 2026; current revision October 21, 2026). Summarized by Beacana; confirm with the payer before relying on it for a specific authorization.