Darbepoetin Alfa (Aranesp)

This policy covers Aranesp (darbepoetin alfa) only for anemia of chronic kidney disease in dialysis and non‑dialysis patients (non‑oncology use; oncology and non‑compendial off‑label uses excluded). Coverage requires pretreatment Hgb <10 g/dL to initiate, ferritin ≥100 mcg/L or TSAT ≥20% or ongoing iron supplementation, exclusion/correction of other causes of anemia, no uncontrolled hypertension or ESA‑associated pure red cell aplasia, documented hemoglobin response for reauthorization (≥1 g/dL increase after ≥12 weeks and current Hgb <12 g/dL), weight‑based dosing (on dialysis 0.45 mcg/kg weekly or 0.75 mcg/kg q2w; not on dialysis 0.45 mcg/kg q4w) and approvals are granted for 6 months.

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

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