Intravenous Iron Replacement Therapy (Feraheme®, Injectafer®, & Monoferric®) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Feraheme (ferumoxytol) and Injectafer (ferric carboxymaltose) for iron deficiency anemia with or without CKD (CKD coverage excludes ESRD) and covers Injectafer for iron deficiency in select NYHA II–III heart failure patients (LVEF <45%, ferritin <100 ng/mL or 100–300 ng/mL with TSAT <20%, Hb <15 g/dL); Monoferric is not medically necessary for the diagnoses in this policy. Coverage requires submission of supporting medical records and labs (obtained 4–12 weeks after the last IV iron), prior failure to ≥2 preferred IV irons (Ferrlecit, Infed, Venofer) or intolerance to all three with prescriber attestation of expected superiority or lack of the same intolerance, dosing per FDA labeling, and authorizations limited to ≤12 months.

"Feraheme (ferumoxytol) and Injectafer (ferric carboxymaltose) are proven for the following indication: Iron Deficiency Anemia (IDA) Without Chronic Kidney Disease (CKD) when the following criteria ..."