MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Louisiana Medicaid updated its Erwinase (asparaginase Erwinia chrysanthemi) pharmacy coverage policy, effective November 1, 2025, with a revision date of July 22, 2026. Coverage requires prior authorization and mandates that members have documented Grade 2-4 hypersensitivity to prior Oncaspar treatment, ALL diagnosis, and use within a multi-agent chemotherapy regimen. The policy excludes members with history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements in the billing system for all Erwinase claims for Louisiana Medicaid members. Update claim submission workflows to require: (1) documentation of ALL diagnosis, (2) evidence of Grade 2-4 hypersensitivity to prior Oncaspar treatment (per CTCAE v4.03 criteria), and (3) confirmation of multi-agent chemotherapy regimen use. Screen all claims for exclusion criteria (serious pancreatitis, thrombosis, hemorrhagic events, or disease progression history) and deny if present. Configure system to auto-deny claims without Grade 2-4 hypersensitivity documentation. Notify oncology providers and pharmacy partners of the updated requirements. Initial approval duration is 6 months; set system reminders for renewal prior authorization requests. Failure to obtain prior authorization will result in claim denials.