MedicaidPrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·LA · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicaid Louisiana revised its Oncaspar (pegaspargase) coverage policy effective February 1, 2026, with updates as of July 22, 2026. This is a Prior Authorization policy for pegaspargase used in acute lymphoblastic leukemia (ALL) treatment. Coverage requires diagnosis of ALL and use as part of multi-agent chemotherapy, with specific exclusions for disease progression, prior thrombosis, pancreatitis, hemorrhagic events, or elevated bilirubin levels.
Action Required
By February 1, 2026: Billing team must implement prior authorization requirements for all Oncaspar (pegaspargase) claims submitted to Humana Medicaid Louisiana. Update billing system to flag J9266 claims and require prior auth before submission. Verify patient meets both criteria (ALL diagnosis AND multi-agent chemotherapy use) and has no exclusions (disease progression on prior asparaginase, history of thrombosis/pancreatitis/hemorrhagic events with prior asparaginase, or total bilirubin >10x ULN). Providers must document clinical justification and screening for exclusion criteria. Initial approval covers 6 months; subsequent renewals also require 6-month reauthorization. Claims submitted without prior authorization will be denied.