Darbepoetin Alfa (Aranesp®)

Covers Aranesp (darbepoetin alfa) only for anemia due to chronic kidney disease (CKD) in patients on dialysis, non‑dialysis patients who meet the policy criteria, and pediatric CKD patients—non‑CKD/non‑FDA‑approved uses and oncology‑related anemia are excluded. Approval requires documentation of CKD and dialysis status, hemoglobin thresholds (non‑dialysis: Hb <10.0 g/dL for ≥18 years or ≤11.0 g/dL for <18 years; current ESA recipients: Hb <11.5 g/dL for ≥18 years or ≤12.0 g/dL for <18 years), evidence of adequate iron stores or current iron therapy for non‑dialysis patients, documentation of current ESA use when applicable, and is authorized for up to 12 months.

"Treatment of anemia due to chronic kidney disease (CKD) in patients on dialysis."

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