Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Summary
This is a historical policy document (originally effective 2019-01-01, most recently revised 2026-07-22) for Erwinase® (asparaginase Erwinia chrysanthemi) pharmacy coverage under Humana's Medicare and Medicaid plans in Florida, Kentucky, and South Carolina. The policy requires prior authorization for Erwinase use in acute lymphoblastic leukemia (ALL) patients with documented Grade 2-4 hypersensitivity to prior pegaspargase treatment, with specific clinical exclusions for serious pancreatitis, thrombosis, hemorrhage, or disease progression on prior asparaginase therapy. The billing team should verify current applicability with Humana before applying this policy, as it was discovered on 2026-10-06 but may have been superseded.
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