MedicaidPrior AuthMedium impact
Erwinase® (asparaginase Erwinia chrysanthemi) (Revised)
Humana·IN · Oncology, Pharmacy·Medicaid
Effective date
Nov 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid Indiana has revised the prior authorization policy for Erwinase (asparaginase Erwinia chrysanthemi), a chemotherapy agent used to treat acute lymphoblastic leukemia (ALL) in patients who developed hypersensitivity to prior asparaginase therapy. The policy requires prior authorization with specific clinical criteria (Grade 2-4 hypersensitivity to Oncaspar documented, use in multi-agent chemotherapy) and excludes patients with serious history of pancreatitis, thrombosis, hemorrhage, or disease progression on asparaginase therapy. Approval is granted for initial and renewal periods of 6 months or as determined through clinical review.
Action Required
Before November 1, 2025: Billing team and oncology providers must implement prior authorization requirement for Erwinase (asparaginase Erwinia chrysanthemi) claims. Update billing system to require documentation of: (1) ALL diagnosis confirmation, (2) Grade 2-4 hypersensitivity to prior Oncaspar therapy (per CTCAE v4.03), and (3) confirmation of multi-agent chemotherapy regimen use. Screen all claims for exclusion criteria: serious pancreatitis history, serious thrombosis history, serious hemorrhage history, or prior disease progression on asparaginase. Verify member eligibility is Medicaid Indiana before processing. Route all Erwinase requests through Humana prior authorization system (reference www.humana.com/PAL for provider claim codes). Establish 6-month re-authorization workflow. Claims submitted without prior authorization approval will be denied. Train oncology office staff to collect required clinical documentation at point of service.