MedicaidPrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·IN · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 21, 2026
Summary
Humana Indiana Medicaid revised its Oncaspar (pegaspargase) coverage policy, effective July 22, 2026. This is a prior authorization requirement for pegaspargase used in multi-agent chemotherapy regimens for acute lymphoblastic leukemia (ALL). The policy includes specific approval criteria, exclusions based on prior adverse events, and a 6-month initial and renewal authorization period.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for Oncaspar (pegaspargase) claims for Indiana Medicaid members. Update billing software to flag all J9262 claims for prior auth before submission. Providers must verify patient meets ALL criteria (ALL diagnosis + use in multi-agent chemotherapy regimen) and does NOT have ANY exclusions (prior disease progression on asparaginase, thrombosis history, pancreatitis history, hemorrhagic events history, or bilirubin >10x ULN) before requesting authorization. Set up authorization tracking for 6-month initial and 6-month renewal periods. Claims submitted without prior authorization will be denied. Front-desk staff should alert oncology providers of this requirement during routine scheduling.