Epoetin alfa (Epogen, Procrit)

Epoetin alfa (Epogen/Procrit/Retacrit) is covered only for three FDA‑approved non‑oncology indications—anemia of chronic kidney disease (dialysis and non‑dialysis), zidovudine‑associated anemia in HIV, and pre‑surgical reduction of allogeneic transfusions—and not for oncology uses. Coverage requires indication‑specific hemoglobin or serum EPO thresholds by age, evidence of adequate iron stores or ongoing iron therapy, proof of current zidovudine or ESA use when applicable, adherence to Units/kg dosing and frequency limits (generally ≤3×/week with specified per‑dose and total‑dose caps for pre‑op use), required documentation (hemoglobin, EPO if used, iron status, procedure details), and is authorized for 12 months for CKD and zidovudine indications and 1 month for pre‑surgical use.

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