Medicare AdvantagePrior AuthMedium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·FL, KY, SC · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Asparlas (calaspargase pegol-mknl) pharmacy coverage policy effective October 22, 2025. This is a prior authorization policy for a pegylated L-asparaginase used in pediatric/young adult ALL treatment (ages ≤21 years). The policy requires prior auth with specific clinical criteria, exclusions for serious adverse history, and 6-month approval/renewal cycles. Billing teams must verify patient age, ALL diagnosis, multi-agent chemotherapy regimen use, and absence of contraindications before claim submission.
Action Required
By October 22, 2025: (1) Billing team must implement prior authorization requirement in claims system for Asparlas. (2) Update EMR/billing software to flag Asparlas prescriptions for patients >21 years old (not covered). (3) Create pre-claim checklist requiring verification of: ALL diagnosis (ICD-10: C91.0x series), multi-agent chemotherapy regimen documentation, patient age ≤21 years, and absence of exclusions (prior thrombosis, pancreatitis, hemorrhage with asparaginase; disease progression on Asparlas; total bilirubin >10x ULN). (4) Providers must submit prior auth requests with clinical documentation before dispensing. (5) Configure system to auto-deny claims for patients age >21 or lacking chemotherapy regimen documentation. Failure to obtain prior authorization will result in claim denials. This applies to Humana Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina members only.