Medicare AdvantagePrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·KY, SC · Hematology, Oncology, Pediatrics·Medicaid
Effective date
Jan 1, 2018
We identified it
Jun 25, 2026
Summary
Humana revised its Oncaspar (pegaspargase) prior authorization policy effective January 1, 2018, with the most recent revision on December 17, 2025. The policy clarifies coverage criteria for pegaspargase as part of multi-agent chemotherapy for acute lymphoblastic leukemia (ALL), requires prior authorization, and specifies five clinical exclusions (disease progression on prior Oncaspar, thrombosis history, pancreatitis history, hemorrhagic events history, and elevated bilirubin >10x ULN). Approval duration is 6 months initially and on renewal, subject to clinical review.
Action Required
By January 15, 2026: Billing team must verify this is the current version of the Oncaspar policy by checking www.humana.com/PAL and update all prior authorization workflows. For Kentucky and South Carolina Medicaid and Medicare members requesting Oncaspar (pegaspargase): (1) Confirm the patient has an ALL diagnosis AND will receive Oncaspar as part of multi-agent chemotherapy before submitting claims; (2) Screen for all five exclusion criteria in the member's record before authorizing; (3) Route all Oncaspar requests through prior authorization process with initial 6-month approval; (4) Document clinical review supporting renewal after 6 months. Providers must submit prior authorization requests with documentation of ALL diagnosis and multi-agent chemotherapy regimen. Claims submitted without prior authorization or for members meeting exclusion criteria will be denied. Update encounter forms and billing system rules to flag Oncaspar for mandatory prior auth in Kentucky and South Carolina Medicaid/Medicare populations.