MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·OH · Oncology, Pediatrics·Medicaid
Effective date
Nov 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid (Ohio) revised its prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi) effective November 1, 2025. The policy requires prior authorization for ALL members with acute lymphoblastic leukemia (ALL) who have Grade 2-4 hypersensitivity to prior pegaspargase (Oncaspar) treatment and are using Erwinase as part of multi-agent chemotherapy. Four specific exclusions apply: history of serious pancreatitis, thrombosis, hemorrhagic events, or disease progression on asparaginase therapy. Initial and renewal approvals are limited to 6 months.
Action Required
Before November 1, 2025: Billing team must establish prior authorization workflows for Erwinase claims submitted to Humana Medicaid Ohio. Coordinate with oncology providers to ensure: (1) ALL diagnoses are documented in claims; (2) Evidence of Grade 2-4 hypersensitivity to prior Oncaspar treatment is obtained before submitting PA requests; (3) Verification that Erwinase is being used as part of multi-agent chemotherapy regimen. Review claims to confirm members do NOT have exclusion criteria (serious pancreatitis, thrombosis, hemorrhagic events, or disease progression history on asparaginase). Update billing system to flag Erwinase claims for mandatory PA submission to Humana. Document all prior authorization approvals with 6-month expiration dates for renewal tracking. Claims submitted without prior authorization will be denied.