MedicaidPrior AuthMedium impact
Asparlas™ (calaspargase pegol-mknl) (Revised)
Humana·OH · Oncology, Pediatrics, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio has issued a revised prior authorization policy for Asparlas (calaspargase pegol-mknl) effective December 1, 2025, with a revision date of July 22, 2026. Prior authorization is required for this drug with strict criteria: patient must have ALL diagnosis, be age ≤21 years, and use it as part of multi-agent chemotherapy. Five specific exclusion criteria may block approval, including prior serious thrombosis, pancreatitis, hemorrhage, disease progression on Asparlas, or elevated bilirubin levels.
Action Required
By December 1, 2025: Billing team must implement prior authorization requirement for all Asparlas (calaspargase pegol-mknl) claims submitted to Humana Medicaid Ohio. Update billing system to flag claims for patients with ALL diagnosis requesting this drug for clinical review before processing. Providers must document: (1) ALL diagnosis confirmation, (2) patient age ≤21 years, (3) multi-agent chemotherapy regimen details, and (4) absence of exclusion criteria (prior thrombosis/pancreatitis/hemorrhage with asparaginase, disease progression on Asparlas, or total bilirubin >10x ULN). Add prior auth checklist to encounter forms or EMR template for oncology staff. Route all requests through Humana's preauthorization system (reference www.humana.com/PAL for coding details). Claims submitted without prior authorization approval will be denied. Initial approval duration is 6 months; renewal requests follow same criteria.