MedicaidPrior AuthMedium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·OH · Oncology, Pediatrics·Medicaid
Effective date
Dec 1, 2025
We identified it
Jul 21, 2026
Summary
This is a revised Humana Medicaid (Ohio) prior authorization policy for Asparlas (calaspargase pegol-mknl), effective December 1, 2025, with a revision date of July 22, 2026. The policy establishes coverage criteria for this pegylated L-asparaginase medication as part of multi-agent chemotherapy for acute lymphoblastic leukemia (ALL) in patients age ≤21 years, and identifies five exclusion criteria that may prevent approval (prior disease progression on Asparlas, history of serious thrombosis/pancreatitis/hemorrhage with asparaginase, or elevated bilirubin >10x ULN).
Action Required
By December 1, 2025: Billing team must implement prior authorization requirement for Asparlas (calaspargase pegol-mknl) claims submitted to Humana Medicaid Ohio. Configure billing system to flag all Asparlas requests for prior auth review before claim submission. Providers must verify patient meets all three approval criteria (ALL diagnosis, multi-agent chemotherapy regimen, age ≤21 years) and does NOT meet any exclusion criteria (prior Asparlas progression, history of thrombosis/pancreatitis/hemorrhage with asparaginase therapy, or total bilirubin >10x ULN). Billing staff should document clinical details supporting medical necessity on preauthorization requests. Initial approvals valid for 6 months; plan renewals accordingly. Claims submitted without prior authorization or from ineligible members will be denied.