Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions

ESAs are nationally covered to treat anemia caused by myelosuppressive anticancer chemotherapy in patients with solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia when started at FDA-label starting doses (epoetin ≤150 U/kg ≤3x/week; darbepoetin 2.25 mcg/kg weekly) and continued only while hemoglobin remains below 10 g/dL. Coverage includes the chemotherapy period and 8 weeks after the final myelosuppressive chemotherapy dose; ESAs are not covered for anemia from specific non-treatment causes (nutritional deficiencies, hemolysis, bleeding, bone marrow fibrosis), for AML/CML or erythroid cancers, for radiotherapy-only anemia, for prophylactic use, for patients with neutralizing antibodies, or when hypertension is uncontrolled. Several policy sentences are incomplete in the source (notably the exact initiation hemoglobin threshold and an exception to discontinuation for rapid hemoglobin rise) and should be reviewed against the complete NCD text for operational details.