Medicare AdvantagePrior AuthMedium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (Revised)
Humana·KY, SC · Oncology, Hematology·Medicaid
Effective date
Sep 15, 2021
We identified it
Jul 23, 2026
Summary
This is a revised Humana prior authorization policy for Rylaze (asparaginase Erwinia chrysanthemi recombinant-rywn) effective September 15, 2021, with a recent revision date of July 22, 2026. The policy requires prior authorization for Rylaze when used to treat ALL or Lymphoblastic Lymphoma in patients with Grade 2-4 hypersensitivity to prior Oncaspar treatment. The policy applies to Medicare, Medicaid in Kentucky, and Medicaid in South Carolina.
Action Required
By July 22, 2026: Billing and clinical teams must ensure all Rylaze intramuscular solution requests include prior authorization. Verify patients meet ALL three criteria: (1) diagnosis of ALL or LBL, (2) documented Grade 2-4 hypersensitivity to Oncaspar based on CTCAE criteria, and (3) use as part of multi-agent chemotherapy. Screen for exclusions: no history of serious pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase therapy. Update prior authorization submission templates to capture hypersensitivity grade documentation and prior Oncaspar exposure. Claims submitted without required prior authorization will be denied. Set approval duration tracking for initial 6-month periods with renewals every 6 months or as determined by clinical review.