MedicaidPrior AuthMedium impact
Provider Letter 2022-12: Re: Prior Authorization of Oncaspar® and Mvasi® – Effective September 15, 2022
Oklahoma SoonerCare·OK · Oncology, Hematology·Prior Authorization
Effective date
Sep 15, 2022
We identified it
Jun 20, 2026
Summary
Starting September 15, 2022, Oklahoma Medicaid (SoonerCare) requires prior authorization for Oncaspar® (pegaspargase) and Mvasi® (bevacizumab-awwb). No prior authorization is needed for Avastin® and Zirabev®. Members currently on therapy will be approved for continuation.
Action Required
By September 15, 2022: Billing team must obtain prior authorization using specific forms PHARM-153 for Oncaspar® and PHARM-166 for Mvasi® before administering these medications to SoonerCare members. Submit PA requests to Pharmacy Prior Authorization Unit via fax (not Medical Authorization Unit or online portal). For patients who started therapy after June 30, 2022, submit PA request with previous dose dates to avoid therapy disruption. Claims will be denied without proper prior authorization.