MedicaidPrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·OH · Oncology, Pediatrics, Hematology·Medicaid
We identified it
Jul 21, 2026
Summary
Oncaspar® (pegaspargase) has a revised Prior Authorization policy for Ohio Medicaid members. The billing team must implement updated prior authorization requirements for this chemotherapy agent to ensure claim approval and avoid denials.
Action Required
Immediately: Billing team must implement prior authorization requirement for Oncaspar® (J9266) for all Ohio Medicaid claims. Update billing system to flag claims for prior auth approval before submission. Providers must document medical necessity and indication (acute lymphoblastic leukemia or lymphoma) on all Oncaspar® orders. Contact Humana Ohio Medicaid for specific prior auth procedures and submission requirements. Claims submitted without prior authorization will be denied.