Epoetin alfa (Epogen, Procrit)

Epoetin alfa is covered only for FDA‑approved non‑oncology uses—anemia of CKD (dialysis and non‑dialysis), zidovudine‑associated anemia in HIV, and preoperative reduction of allogeneic transfusions for elective noncardiac/nonvascular surgery; oncology indications are excluded. Coverage requires indication‑specific lab/clinical criteria (CKD and zidovudine initial Hgb <10 g/dL; pre‑surgical Hgb >10–≤13 g/dL), ferritin ≥100 mcg/L or TSAT ≥20% or ongoing iron supplementation, exclusion/correction of other anemia causes, no uncontrolled hypertension or ESA‑induced pure red‑cell aplasia, plus zidovudine dose ≤4,200 mg/week and endogenous EPO ≤500 mU/mL for zidovudine cases; reauthorization requires documented hemoglobin response (CKD: ≥1 g/dL after ≥12 weeks; zidovudine: response after ≥8 weeks at 300 U/kg) and current Hgb <12 g/dL, with approvals limited to 6 months for CKD/zidovudine and 2 months for pre‑surgical use.

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