MedicaidPrior AuthMedium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Rylaze (asparaginase erwinia chrysanthemi recombinant-rywn), effective July 22, 2026. Coverage requires ALL diagnosis of ALL/LBL, documented Grade 2-4 hypersensitivity to prior pegaspargase therapy, and use as part of multi-agent chemotherapy. Four serious exclusions apply: history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy.
Action Required
By July 22, 2026: Billing team must implement prior authorization workflow for Rylaze claims submitted by oncology providers. Update billing system to require documentation of: (1) ALL or LBL diagnosis, (2) Grade 2-4 hypersensitivity to pegaspargase with clinical evidence, and (3) confirmation of multi-agent chemotherapy regimen. Create internal checklist to screen for four exclusionary conditions before submission. Providers must obtain prior auth approval before dispensing; initial approval valid 6 months or as clinically reviewed. Route all Rylaze prior auth requests through standard Humana Ohio Medicaid PA channels. Set internal reminders to notify providers of renewal requirements 30 days before 6-month approval expires. Claims submitted without prior authorization or missing required documentation will be denied.