Medicare AdvantagePrior AuthMedium impact
Oncaspar® (pegaspargase) (Revised)
Humana·KY, SC · Oncology, Hematology, Pediatrics·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Oncaspar® (pegaspargase) affecting Medicare and Medicaid members in Kentucky and South Carolina. The policy update requires billing teams to verify current prior authorization requirements before submitting claims for this oncology medication.
Action Required
Immediately: Billing and clinical staff must access the complete revised Oncaspar® prior authorization policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58680c to determine current requirements. For all claims with HCPCS code J9019 (pegaspargase) submitted to Humana Medicare Advantage, Traditional Medicare, Medicaid-Kentucky, or Medicaid-South Carolina: (1) Verify whether prior authorization is required under the revised policy; (2) Update billing system rules and clinical workflows accordingly; (3) Brief providers and nursing staff on any new documentation or authorization requirements. Claims submitted without following the revised policy requirements will be denied. Contact Humana directly or consult the policy source URL for specific authorization criteria and submission procedures.