Medicare AdvantagePrior AuthMedium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·FL, KY, SC · Oncology, Pediatrics·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
This is a revised Humana prior authorization policy for Asparlas (calaspargase pegol-mknl) effective July 22, 2026. The policy covers this pegylated L-asparaginase as a component of multi-agent chemotherapy regimens for acute lymphoblastic leukemia (ALL) in pediatric and young adult patients ≤21 years old. Prior authorization is required, with initial and renewal approvals valid for 6 months. Key exclusions include disease progression on prior Asparlas, history of serious thrombosis, pancreatitis, hemorrhagic events, or severely elevated bilirubin.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for all Asparlas (calaspargase pegol-mknl) claims for Medicaid members in Florida, Kentucky, and South Carolina, and Medicare members. Before submitting claims, verify the member meets ALL THREE approval criteria: (1) ALL diagnosis, (2) use in multi-agent chemotherapy regimen, (3) age ≤21 years. Screen for ANY of the five exclusions listed in the policy—if present, prior authorization may be denied. Update claim submission workflows to require prior auth submission before dispensing. Configure billing system to flag Asparlas claims for manual review against exclusion criteria. Ensure prior auth is obtained with 6-month validity; request renewal 30 days before expiration. Failure to obtain prior authorization will result in claim denials. Reference the policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58680e for current status.