MedicaidPrior AuthMedium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn)
Humana·OH · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Jul 22, 2026
We identified it
Aug 12, 2026
Summary
Humana has issued a NEW prior authorization policy (effective July 22, 2026) for Rylaze (asparaginase erwinia chrysanthemi recombinant-rywn) for Ohio Medicaid members. The drug is covered ONLY for patients with ALL or LBL who developed Grade 2-4 hypersensitivity to prior Oncaspar therapy AND are using Rylaze as part of multi-agent chemotherapy. Four specific contraindications will result in denial: history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on prior asparaginase therapy.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for Rylaze claims submitted for Ohio Medicaid members. Before submitting claims: (1) Verify member has documented Grade 2-4 hypersensitivity to Oncaspar (pegaspargase) from prior treatment; (2) Confirm diagnosis of ALL or LBL; (3) Ensure Rylaze is part of multi-agent chemotherapy regimen; (4) Screen for any history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy—if any exclusion exists, do NOT submit for authorization; (5) Route all Rylaze requests through prior authorization process with 6-month approval duration. Update billing software to flag Rylaze for mandatory pre-authorization for Ohio Medicaid only. Provider team must document hypersensitivity grade level and prior Oncaspar treatment in medical record before billing submits authorization request. Claims submitted without prior authorization will be denied. Reference source: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5a131a