Mircera — 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)
- Prescriber is specialist or has consult
- No FDA labeled contraindications
Approval duration
12 months