Erythropoiesis-Stimulating Agents (ESAs)

This policy covers erythropoiesis‑stimulating agents (ESAs) for treatment of anemia and to reduce allogeneic red blood cell transfusions, including anemia of chronic kidney disease (CKD/ESRD), AZT‑related anemia in HIV (endogenous EPO ≤500 mUnits/mL), anemia from ribavirin/ interferon hepatitis C therapy, selected preoperative patients with specified Hb thresholds, aplastic anemia and other non-oncologic indications. Coverage requires evidence of efficacy and adherence to authoritative dosing/frequency/duration (e.g., FDA labeling, compendia), off‑label uses must be supported by accepted compendia or ≥2 peer‑reviewed articles, iron stores must be adequate (ferritin ≥100 ng/mL or TSAT ≥20%), blood pressure must be controlled and monitored, dosing must be the lowest effective, oncologic ESA use is excluded, and benefits are subject to HCSC Ohio member plan limits.

"Therapies are covered when proven effective for the relevant diagnosis or procedure based on current peer‑reviewed literature and standards of practice."