MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Sep 24, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Erwinase (asparaginase Erwinia chrysanthemi) prior authorization policy effective September 24, 2025. The policy maintains coverage for ALL patients with Grade 2-4 hypersensitivity to prior Oncaspar treatment, requires prior authorization, and reinforces four specific exclusion criteria (serious pancreatitis, thrombosis, hemorrhagic events, or disease progression with prior asparaginase therapy). Approval duration remains 6 months for both initial and renewal requests.
Action Required
By September 24, 2025: Billing team must implement prior authorization workflow for all Erwinase claims across Florida, Kentucky, and South Carolina Medicaid programs. Verify patient eligibility against three approval criteria: (1) ALL diagnosis documented, (2) Grade 2-4 hypersensitivity to Oncaspar confirmed, (3) use in multi-agent chemotherapy regimen. Screen for four exclusions before submission: serious pancreatitis history, serious thrombosis history, serious hemorrhagic events, or disease progression on prior asparaginase therapy. Update billing system to flag claims missing required clinical documentation and set 6-month approval tracking for renewals. Route all prior authorization requests through established Humana PAL system at www.humana.com/PAL. Communicate with oncology providers to ensure hypersensitivity grade documentation (per CTCAE v4.03 criteria) is included with claims. Claims submitted without prior authorization or missing required clinical criteria will be denied.