MedicaidPrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·KY, SC · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana revised its Oncaspar (pegaspargase) prior authorization policy effective July 22, 2026. The policy maintains prior authorization requirements for ALL members with acute lymphoblastic leukemia (ALL) using Oncaspar as part of multi-agent chemotherapy, with five key exclusions that will trigger approval denial (disease progression on prior Oncaspar, serious thrombosis/pancreatitis/hemorrhage with prior asparaginase, or total bilirubin >10x ULN). Approval duration remains 6 months for both initial and renewal.
Action Required
By July 22, 2026: Billing and prior authorization teams must update internal protocols to ensure all Oncaspar (pegaspargase) requests for Medicaid members in Kentucky and South Carolina include verification against the five exclusion criteria before submission. Specifically: (1) Confirm member does NOT have documented disease progression while on/after prior Oncaspar therapy; (2) Verify NO history of serious thrombosis, pancreatitis, or hemorrhagic events with prior L-asparaginase; (3) Confirm total bilirubin is NOT >10 times upper limit of normal. Update your prior authorization submission checklist/EMR templates to include these screening questions. Clinical staff reviewing requests should deny authorization immediately if any exclusion is present. Failure to screen for exclusions may result in unnecessary authorization attempts and claim denials. Providers must continue to document that Oncaspar is being used as a component of multi-agent chemotherapy regimen for ALL diagnosis.