Medicare AdvantagePrior AuthMedium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jul 23, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Rylaze (asparaginase Erwinia chrysanthemi recombinant-rywn) effective July 23, 2025. The policy clarifies that coverage requires: (1) diagnosis of ALL or LBL, (2) documented Grade 2-4 hypersensitivity to prior Oncaspar treatment, and (3) use as part of multi-agent chemotherapy. Four serious adverse event exclusions apply: prior pancreatitis, thrombosis, hemorrhage, or disease progression with asparaginase-based therapy. Prior authorization remains required with 6-month approval duration for both initial and renewal requests.
Action Required
By July 23, 2025: Billing and clinical teams must implement updated prior authorization requirements for Rylaze claims. Update billing system and EMR to require: (1) verification of ALL or LBL diagnosis, (2) documentation of Grade 2-4 hypersensitivity reaction to prior Oncaspar treatment, and (3) confirmation that Rylaze is part of multi-agent chemotherapy regimen. Implement exclusion screening checklist to identify and deny claims for members with history of serious pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase therapy. Train prior authorization staff on new clinical criteria. Set system reminders for 6-month renewal reviews. Document all criteria in prior authorization requests submitted to Humana. Failure to meet these requirements will result in claim denials.