Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)

REQUIREMENTS: - By November 1, 2025: Billing and authorization teams must implement prior authorization requirement for Erwinase® (asparaginase Erwinia chrysanthemi) claims in the Humana Medicaid Ohio line of business. - Create a prior authorization checklist requiring verification of ALL three approval criteria before submitting claims: (1) documented ALL diagnosis, (2) Grade 2-4 hypersensitivity to prior Oncaspar therapy based on CTCAE criteria, and (3) use as part of multi-agent chemotherapy regimen. - Screen for and document exclusion status for each of the four contraindications: history of serious pancreatitis, serious thrombosis, serious hemorrhagic events, or disease progression on prior asparaginase therapy. - Update billing software/EMR templates to flag Erwinase® prescriptions for manual or automated prior authorization review before claim submission. - Coordinate with oncology providers and pharmacy teams to ensure clinical documentation supports all criteria and exclusions are clearly documented in patient records. - Set initial approval duration to 6 months maximum; establish renewal process for continuing therapy beyond initial approval period. - Ensure all billing staff are trained on CTCAE v4.03 hypersensitivity grading criteria (specifically Grade 2-4 definitions) to support clinical review. - Failure to obtain prior authorization will result in claim denials under this Medicaid Ohio policy. - Reference www.humana.com/PAL for current provider claim codes related to this drug and prior authorization requirements.