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Effective May 1, 2006 (Texas effective date: June 15, 2006).
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Requires a pathology report to be submitted with the initial claim for Herceptin.
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Subsequent physician claims for Herceptin for patients with previously documented HER2 overexpression will be paid without requiring a pathology report.
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Failure to document HER2 gene amplification (ImmunoHistoChemistry test - IHC of 3+ or Fluorescence In Situ Hybridization test - FISH amplification of 2.1 or greater) will cause the use of Herceptin to be ineligible for reimbursement.
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