Aranesp (darbepoetin alfa) Non-oncology

EviCore covers Aranesp (darbepoetin alfa) only for anemia due to chronic kidney disease (CKD) — including dialysis patients, non‑dialysis patients who meet specified hemoglobin/iron criteria, and pediatric CKD anemia — and excludes oncology or other non‑CKD indications. Coverage requires documentation of CKD and dialysis status, adequate iron stores or ongoing iron therapy for non‑dialysis patients, baseline hemoglobin thresholds for initiation (age ≥18: Hb <10.0 g/dL; age <18: Hb ≤11.0 g/dL; current ESA users: Hb ≤12.0 g/dL), appropriate weight‑/dialysis‑based dosing, and supports up to 12 months authorization.

"Anemia due to chronic kidney disease (CKD) in patients on dialysis (FDA-approved non-oncology indication)."

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