Traditional MedicarePrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2019
We identified it
Aug 12, 2026
Summary
This is a revised Humana prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi) effective for Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy requires prior auth for ALL patients with acute lymphoblastic leukemia receiving Erwinase, with specific approval criteria including documented Grade 2-4 hypersensitivity to prior pegaspargase treatment and use as part of multi-agent chemotherapy. Four clinical exclusions apply: history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on prior asparaginase therapy.
Action Required
By December 31, 2026: Billing and clinical teams must implement prior authorization requirements for all Erwinase claims across affected plans (Medicare, Florida Medicaid, Kentucky Medicaid, South Carolina Medicaid). Update billing system to flag Erwinase claims for mandatory PA review. Providers must document: (1) ALL diagnosis confirmation, (2) Grade 2-4 hypersensitivity to prior Oncaspar therapy with CTCAE grading, (3) multi-agent chemotherapy regimen context, and (4) absence of four listed exclusion criteria. Clinical reviewers must verify all three criteria are met before approval. Initial approvals valid for 6 months; renewals also valid 6 months. Obtain PA before dispensing; claims submitted without prior authorization will be denied. Reference www.humana.com/PAL for specific claim codes.