MedicaidPrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·OH · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Feb 1, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicaid-Ohio has revised its Oncaspar (pegaspargase) prior authorization policy, effective February 1, 2026, with the most recent revision dated July 22, 2026. This is a pharmacy coverage policy requiring prior authorization for pegaspargase use in acute lymphoblastic leukemia (ALL) patients as part of multi-agent chemotherapy. The policy establishes specific approval criteria, exclusion criteria (including prior serious thrombosis, pancreatitis, or hemorrhagic events with asparaginase therapy), and a 6-month initial and renewal approval duration.
Action Required
Before February 1, 2026: Billing team must configure the billing system to require prior authorization for HCPCS code J9266 (pegaspargase) for all Medicaid-Ohio members. Pharmacy and clinical staff must verify that all Oncaspar requests meet BOTH approval criteria: (1) member has ALL diagnosis, AND (2) drug is used as component of multi-agent chemotherapy regimen. Deny any requests meeting exclusion criteria: prior disease progression on Oncaspar, history of serious thrombosis/pancreatitis/hemorrhagic events with prior asparaginase therapy, or total bilirubin >10x upper limit of normal. Set initial and renewal approvals for 6 months or as determined through clinical review. Update prior authorization forms and workflows to capture these criteria. Failure to obtain prior authorization will result in claim denials for Ohio Medicaid members.