MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·IN · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Nov 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has issued a revised prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi) effective November 1, 2025, with a revision dated July 22, 2026. Coverage requires documentation of Grade 2-4 hypersensitivity to prior pegaspargase treatment, use in multi-agent chemotherapy for acute lymphoblastic leukemia (ALL), and exclusion of patients with serious pancreatitis, thrombosis, hemorrhage, or disease progression on prior asparaginase therapy. Initial and renewal approvals are valid for 6 months or as determined through clinical review.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements in billing system for Erwinase (HCPCS J9019) claims submitted to Humana Indiana Medicaid. All claims for this drug must include: (1) documentation of ALL diagnosis, (2) evidence of Grade 2-4 hypersensitivity reaction to prior pegaspargase treatment (using CTCAE v4.03 criteria), (3) verification of use in multi-agent chemotherapeutic regimen, and (4) confirmation of absence of exclusionary conditions (serious pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase). Update oncology provider encounter templates to remind clinical staff of required documentation elements. Establish workflow to screen claims for exclusionary criteria before submission. Notify oncology providers and infusion centers of the specific criteria required for authorization. Claims submitted without complete documentation of Criteria #1-3 and exclusion verification will be denied or delayed pending medical review. Track all approvals for 6-month renewal review cycles.