Epoetin alfa (Epogen®, Procrit®, Retacrit®)

Epoetin alfa (Epogen®, Procrit®, Retacrit®) is covered only for FDA‑approved non‑oncology indications—anemia of CKD (dialysis and non‑dialysis), zidovudine‑associated anemia in HIV, and preoperative reduction of allogeneic transfusion for elective nonvascular/noncardiac surgery—and oncology or other non‑listed uses are excluded. Coverage requires meeting indication‑specific hemoglobin thresholds (e.g., initial CKD or zidovudine Hb <10.0 g/dL, preop Hb ≤13.0 g/dL, and continuation thresholds ~11.5–12.0 g/dL for ongoing ESA), demonstration of adequate iron stores or current iron therapy, documentation of dialysis/zidovudine/ESA status (and serum EPO ≤500 mU/mL when claimed), and approvals are limited to 1 month for surgery and 12 months for other indications.

"Anemia associated with chronic kidney disease (CKD) in individuals on dialysis and individuals not on dialysis"