Aranesp — Blue Cross Blue Shield of Oklahoma
Anemia associated with chronic kidney disease (including ESRD)
Initial criteria
- Prior to starting requested agent, iron stores evaluated (ferritin ≥ 100 ng/mL OR transferrin saturation ≥ 20%)
- Iron stores maintained during therapy
- Blood pressure adequately controlled and monitored before and during therapy
- ESA dose is lowest sufficient to avoid need for RBC transfusion
- For CKD: Hgb < 11 g/dL (or < 10 g/dL initiating)
- For cancer on myelosuppressive chemotherapy: anemia caused by chemotherapy, anticipated outcome not cure, Hgb ≤ 12 g/dL (or approaching/<10 g/dL initiating)
- For MDS: to reduce transfusion dependency
- Prescriber is specialist or has consult
- No FDA labeled contraindications
Approval duration
CKD or MDS: 12 months; chemotherapy-related anemia: 6 months; others: 6 months