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HumanaMedicaid · Prior Auth · Medicaid · KY, SC · Oncology, Pediatrics, HematologyMedium impact

Oncaspar® (pegaspargase) (Revised)

Act
by Jul 22, 2026
Effective date
Jul 22, 2026
Identified
Jul 22, 2026

Summary

Humana revised its Oncaspar (pegaspargase) prior authorization policy effective July 22, 2026. The policy maintains prior authorization requirements for ALL members with acute lymphoblastic leukemia (ALL) using Oncaspar as part of multi-agent chemotherapy, with five key exclusions that will trigger approval denial (disease progression on prior Oncaspar, serious thrombosis/pancreatitis/hemorrhage with prior asparaginase, or total bilirubin >10x ULN). Approval duration remains 6 months for both initial and renewal.

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What to do

by Jul 22, 2026 · 8 steps
01Billing and prior authorization teams must update internal protocols to ensure all Oncaspar (pegaspargase) requests for Medicaid members in Kentucky and South Carolina include verification against the five exclusion criteria before submission.
02Confirm member does NOT have documented disease progression while on/after prior Oncaspar therapy.
03Verify NO history of serious thrombosis, pancreatitis, or hemorrhagic events with prior L-asparaginase.
04Confirm total bilirubin is NOT >10 times upper limit of normal.
05Update your prior authorization submission checklist/EMR templates to include these screening questions.
06Clinical staff reviewing requests should deny authorization immediately if any exclusion is present.
07Failure to screen for exclusions may result in unnecessary authorization attempts and claim denials.
08Providers must continue to document that Oncaspar is being used as a component of multi-agent chemotherapy regimen for ALL diagnosis.

Codes mentioned

J9019

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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Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)MediumEffective Nov 1, 2025 · 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

Related policy hubs

Humana policiesKY policy changesSC policy changesOncologyPediatricsHematologyCode J9019

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