Perjeta® (pertuzumab)

Authorization form

Traditional, Optimized & Medicaid (11/2018)

No prior authorization is required for Medicare

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J9306

Benefit: Medical

Notes: Treatment of HER2-positive metastatic breast cancer