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HumanaMedicare Advantage · Prior Auth · Medicaid · KY, SC · Hematology, Oncology, PediatricsMedium impact

Oncaspar® (pegaspargase) (Revised)

Act
by Jan 15, 2026
Effective date
Jan 1, 2018
Identified
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.

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What to do

by Jan 15, 2026 · 9 steps
01Billing team must verify this is the current version of the Oncaspar policy by checking www.humana.com/PAL and update all prior authorization workflows.
02For Kentucky and South Carolina Medicaid and Medicare members requesting Oncaspar (pegaspargase).
03Confirm the patient has an ALL diagnosis AND will receive Oncaspar as part of multi-agent chemotherapy before submitting claims.
04Screen for all five exclusion criteria in the member's record before authorizing.
05Route all Oncaspar requests through prior authorization process with initial 6-month approval.
06Document clinical review supporting renewal after 6 months.
07Providers must submit prior authorization requests with documentation of ALL diagnosis and multi-agent chemotherapy regimen.
08Claims submitted without prior authorization or for members meeting exclusion criteria will be denied.
09Update encounter forms and billing system rules to flag Oncaspar for mandatory prior auth in Kentucky and South Carolina Medicaid/Medicare populations.

Original notice

Oncaspar® (pegaspargase) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

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Oncaspar® (pegaspargase) (Revised)MediumEffective Jul 22, 2026 · MedicaidOncaspar® (pegaspargase) (Revised)MediumEffective Jul 22, 2026 · MedicaidOncaspar® (pegaspargase) (Revised)MediumEffective Feb 1, 2026 · MedicaidOncaspar® (pegaspargase) (Revised)MediumEffective Feb 1, 2026 · MedicaidBrowse every Humana change in the policy list

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