MedicaidPrior AuthMedium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·LA · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid Louisiana has revised its prior authorization policy for Asparlas (calaspargase pegol-mknl), a chemotherapy drug for acute lymphoblastic leukemia (ALL) in patients age ≤21 years. The policy clarifies approval criteria requiring ALL diagnosis, use in multi-agent chemotherapy regimens, and age restrictions, while identifying five specific exclusions (disease progression on Asparlas, history of serious thrombosis/pancreatitis/hemorrhage with prior asparaginase therapy, and elevated bilirubin >10x upper limit of normal). Prior authorization is required for all Asparlas claims under this plan.
Action Required
Before December 1, 2025: Billing team must implement prior authorization requirement in billing system for all Asparlas (calaspargase pegol-mknl) intravenous solution claims for Humana Medicaid Louisiana members. Update claim submission procedures to require prior auth before billing; configure system to flag any Asparlas claims lacking authorization. Verify member age (≤21 years) and ensure provider documentation confirms ALL diagnosis and multi-agent chemotherapy regimen use. Screen for exclusion criteria (prior disease progression, thrombosis history, pancreatitis history, hemorrhage history, bilirubin >10x ULN) before submission. Approval duration is 6 months initial and 6 months renewal. Claims submitted without prior authorization will be denied. Train billing and prior auth staff on the five exclusion criteria. Reference the current policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584852 before submitting any claims.