Mircera(methoxy polyethylene glycol- epoetin beta)

Covered: Mircera is covered only for anemia of chronic kidney disease per FDA‑approved indications — adults on or not on dialysis and pediatric patients 3 months–17 years only when converting from another ESA after a stabilized hemoglobin — and is not authorized for non‑FDA uses or pediatric doses <30 mcg (prefilled syringe limitation). Key requirements: documentation of CKD anemia and dialysis status, recent Hb (initial non‑dialysis <10.0 g/dL; if already on an ESA Hb ≤12.0 g/dL), evidence of adequate iron or current iron therapy, adherence to specified weight‑based dosing/route (maintain route if <6 years) and conversion dose calculations; approvals limited to 12 months.

"Treatment of anemia associated with chronic kidney disease (CKD) in adult patients not on dialysis (FDA‑approved)."

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