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HumanaMedicaid · Prior Auth · Medicaid · LA · Oncology, HematologyMedium impact

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Act
by Nov 1, 2025
Effective date
Nov 1, 2025
Identified
Jul 21, 2026

Summary

Humana Louisiana Medicaid updated its Erwinase (asparaginase Erwinia chrysanthemi) pharmacy coverage policy, effective November 1, 2025, with a revision date of July 22, 2026. Coverage requires prior authorization and mandates that members have documented Grade 2-4 hypersensitivity to prior Oncaspar treatment, ALL diagnosis, and use within a multi-agent chemotherapy regimen. The policy excludes members with history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy.

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What to do

by Nov 1, 2025 · 6 steps
01Billing team must implement prior authorization requirements in the billing system for all Erwinase claims for Louisiana Medicaid members.
02Update claim submission workflows to require: (1) documentation of ALL diagnosis, (2) evidence of Grade 2-4 hypersensitivity to prior Oncaspar treatment (per CTCAE v4.03 criteria), and (3) confirmation of multi-agent chemotherapy regimen use.
03Screen all claims for exclusion criteria (serious pancreatitis, thrombosis, hemorrhagic events, or disease progression history) and deny if present.
04Configure system to auto-deny claims without Grade 2-4 hypersensitivity documentation.
05Notify oncology providers and pharmacy partners of the updated requirements.
06Initial approval duration is 6 months; set system reminders for renewal prior authorization requests.
If missed: Failure to obtain prior authorization will result in claim denials.

Codes mentioned

J9019

Original notice

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Oncaspar® (pegaspargase) (Revised)MediumEffective Jul 22, 2026 · MedicaidErwinase® (asparaginase Erwinia chrysanthemi) (Revised)MediumEffective Jan 1, 2019 · MedicaidErwinase® (asparaginase Erwinia chrysanthemi) (Revised)MediumEffective Nov 1, 2025 · MedicaidErwinase® (asparaginase Erwinia chrysanthemi) (Revised)LowEffective Nov 1, 2025 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesLA policy changesOncologyHematologyCode J9019

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