Epogen®, Procrit®, Retacrit® (epoetin alfa) Injection Non-oncology

Epoetin alfa (Epogen, Procrit, Retacrit) is covered for FDA‑approved non‑oncology indications — anemia of chronic kidney disease (dialysis and non‑dialysis), zidovudine‑associated anemia in HIV, and to reduce allogeneic transfusions for selected elective nonvascular, noncardiac surgeries — and is not covered for oncology indications. Coverage requires meeting specific criteria (hemoglobin thresholds: non‑dialysis adults initial Hb <10.0 g/dL [≤11.0 g/dL if <18 yrs]; patients already on an ESA Hb ≤12.0 g/dL; zidovudine‑anemia initial Hb <10.0 g/dL or serum EPO ≤500 mU/mL; surgical use Hb ≤13.0 g/dL), documented adequate iron stores or current iron therapy, current zidovudine use for that indication, documentation that the surgery is elective/nonvascular/noncardiac and the patient cannot/will not donate autologous blood, required labs/clinical documentation, and approval durations of 1 month for surgery and 12 months for other indications.

"FDA-approved non-oncology indications"