MedicaidPrior AuthLow impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·IN · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jul 21, 2026
Summary
This is a revised Medicaid (Indiana) prior authorization policy for Asparlas (calaspargase pegol-mknl), a pegylated L-asparaginase used to treat acute lymphoblastic leukemia (ALL) in pediatric and young adult patients. The policy requires prior authorization and specifies strict age criteria (≤21 years), exclusionary conditions (prior thrombosis, pancreatitis, hemorrhagic events, disease progression on Asparlas, or severely elevated bilirubin), and initial/renewal approval durations of 6 months or as determined by clinical review.
Action Required
By December 1, 2025: Billing team and prior authorization staff must implement this Medicaid Indiana policy for Asparlas (calaspargase pegol-mknl) intravenous solution. Before submitting claims, verify the patient meets ALL three criteria: (1) diagnosis of ALL, (2) use as part of multi-agent chemotherapy, and (3) age ≤21 years. Screen for the five exclusions (disease progression on Asparlas, prior serious thrombosis/pancreatitis/hemorrhagic events with asparaginase therapy, or total bilirubin >10× upper limit of normal). Submit prior authorization requests to Humana Indiana Medicaid with clinical documentation supporting all criteria. Set authorization reminders for 6-month renewal or as determined by clinical review. Claims submitted without approved prior authorization will be denied. Contact Humana at the PAL (Preauthorization and Notification List) portal at www.humana.com/PAL for medical billing code requirements.