Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)

Covered: Mircera is approved for anemia due to chronic kidney disease in adults (on dialysis or not) and pediatric patients on hemodialysis, and is not supported for non‑CKD anemia or for CKD patients who do not meet the policy criteria. Key requirements: approval requires documented CKD-related anemia with age-specific thresholds (≥5 years for dialysis pediatric use, ≥18 years for non‑dialysis), recent Hgb meeting initiation/continuation cutoffs (<10/≤11 g/dL for initiation and <11.5/≤12 g/dL for continuation depending on age and dialysis status), evidence of current iron therapy or adequate iron stores, adherence to dosing limits (adults: ≤180 mcg every ≥2 weeks or ≤360 mcg monthly; pediatrics: dosing ≤ q4 weeks with specified conversion formulas from epoetin/darbepoetin), and authorization is limited to 12 months with required supporting documentation.

"Treatment of anemia associated with chronic kidney disease (CKD) in adult individuals on dialysis."