- Treatment of anemia due to chronic kidney disease (CKD), including patients on dialysis and patients not on dialysis to decrease the need for red blood cell (RBC) transfusion.
- For the treatment of anemia due to zidovudine administered at < 4200 mg per week in HIV-infected patients with endogenous serum erythropoietin levels of < 500 mUnits/mL. (Epogen/Procrit only)
- For the treatment of anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.
- To reduce the need for allogeneic RBC transfusions among patients with perioperative hemoglobin > 10 to ≤ 13 g/dL who are at high risk for perioperative blood loss from elective, noncardiac, nonvascular surgery. It is not indicated for patients who are willing to donate autologous blood pre-operatively. (Epogen/Procrit only)
- Limitations of Use:
- Have not been shown to improve quality of life, fatigue, or patient well-being.
- Not indicated for use:
- In patients with cancer receiving hormonal agents, biologic products, or radiotherapy, unless also receiving concomitant myelosuppressive chemotherapy.
- In patients with cancer receiving myelosuppressive chemotherapy when the outcome is cure.
- In patients scheduled for surgery who are willing to donate autologous blood.
- In patients undergoing cardiac or vascular surgery.
- As a substitute for RBC transfusions in patients who require immediate correction of anemia.
- For the treatment of anemia associated with chronic kidney disease (CKD) in adult patients on dialysis and patients not on dialysis
Coverage of drugs is first determined by the member’s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document.