Medicare AdvantagePrior AuthMedium impact
Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) (Revised)
Humana·KY, SC · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jul 22, 2026
We identified it
Aug 12, 2026
Summary
Humana updated its Rylaze (asparaginase Erwinia chrysanthemi recombinant-rywn) prior authorization policy effective July 22, 2026, for Medicare and Medicaid members in Kentucky and South Carolina. This is a specialized oncology drug requiring prior authorization for ALL/LBL patients with documented Grade 2-4 hypersensitivity to prior asparaginase therapy. The policy maintains existing approval duration (6 months initial and renewal) and exclusion criteria for serious pancreatitis, thrombosis, hemorrhagic events, or disease progression.
Action Required
By July 22, 2026: Billing and prior authorization teams must implement updated Rylaze coverage requirements in Humana management systems for Kentucky and South Carolina Medicaid and Medicare plans. Ensure prior authorization denials include: (1) confirmation patient has ALL/LBL diagnosis, (2) verification of Grade 2-4 hypersensitivity to Oncaspar (pegaspargase) with documentation, (3) confirmation Rylaze is part of multi-agent chemotherapy regimen, and (4) screening for exclusions (pancreatitis, thrombosis, hemorrhage history, or disease progression on prior asparaginase). Update authorization templates to set 6-month approval duration. Train oncology billing staff on revised criteria. Flag claims lacking Grade 2-4 hypersensitivity documentation for denial or additional documentation request, as this is the key medical necessity criterion.