Payer PolicyActive
Aranesp (darbepoetin alfa) Non-oncology
EVICORE-MEDICAL_DRUG-E41B96A3
EviCore by Evernorth
Effective: October 1, 2023
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Aranesp is covered only for non‑oncology anemia due to chronic kidney disease in patients on dialysis and in patients not on dialysis (other indications are excluded). Coverage requires documentation of CKD and dialysis status, and for patients not on dialysis adequate iron stores or current iron therapy plus hemoglobin thresholds for initial authorization <10.0 g/dL in adults (≥18) or ≤11.0 g/dL in <18; if already on an ESA, thresholds are <11.5 g/dL in adults or ≤12.0 g/dL in <18, with approvals limited to 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Aranesp is indicated for the treatment of anemia due to chronic kidney disease (CKD) in patients on dialysis."
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