Erythropoiesis Stimulating Agents

Aetna requires precertification and covers erythropoiesis-stimulating agents (Aranesp, Epogen/Procrit, Retacrit, Mircera) only for anemia due to chronic kidney disease, anemia from myelosuppressive chemotherapy for nonmyeloid malignancies, and anemia in myelodysplastic syndrome when pretreatment hemoglobin is <10 g/dL; all other indications are considered experimental/investigational. Key requirements: pretreatment hemoglobin <10 g/dL (excluding values due to recent transfusion), no concomitant use of multiple ESAs, and continuation after ≥12 weeks requires a hemoglobin rise ≥1 g/dL (members treated <12 weeks without response may continue up to 12 weeks to allow assessment).

"Anemia due to chronic kidney disease (CKD) - for treatment in members with pretreatment hemoglobin less than 10 g/dL;"

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