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HumanaMedicaid · Prior Auth · Medicaid · FL, KY, SC · Oncology, Hematology, PharmacyMedium impact

Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

Act
by Jul 22, 2026 (policy revision date)
Effective date
Jan 1, 2019
Identified
Jul 22, 2026

Summary

This is a recent revision (July 22, 2026) to Humana's Erwinase prior authorization policy for Medicaid members in Florida, Kentucky, and South Carolina. The policy establishes strict prior authorization requirements for Erwinase use in acute lymphoblastic leukemia (ALL) patients, requiring documented Grade 2-4 hypersensitivity to prior pegaspargase treatment and excluding patients with serious pancreatitis, thrombosis, hemorrhage, or disease progression history on asparaginase therapy.

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What to do

by Jul 22, 2026 (policy revision date) · 6 steps
01Billing team must implement prior authorization requirements for Erwinase (HCPCS code J9060) across Medicaid plans in Florida, Kentucky, and South Carolina.
02Update billing system to require prior auth submission with documentation of: (1) ALL diagnosis confirmation, (2) documented Grade 2-4 hypersensitivity to prior Oncaspar treatment based on CTCAE criteria, and (3) confirmation that Erwinase is used as part of multi-agent chemotherapy.
03Providers must screen for exclusion criteria (serious pancreatitis, thrombosis, hemorrhage, or disease progression history with asparaginase).
04Claims submitted without prior authorization or meeting exclusion criteria will be denied.
05Update encounter templates and claim submission workflows to capture required clinical documentation.
06Initial and renewal approvals valid for 6 months.

Codes mentioned

J9060

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 →
Erwinase® (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 · MedicaidErwinase® (asparaginase Erwinia chrysanthemi) (Revised)MediumEffective Nov 1, 2025 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesFL policy changesKY policy changesSC policy changesOncologyHematologyPharmacyCode J9060

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