Epogen — Blue Cross Blue Shield of Texas

Initial criteria

• Prior to starting the requested agent, iron stores were evaluated and ferritin ≥ 100 ng/mL OR transferrin saturation ≥ 20%
• Iron stores will be maintained before and while using ESA therapy
• Blood pressure will be adequately controlled and closely monitored before and during ESA therapy
• ESA dose is the lowest dose to gradually increase hemoglobin to the level sufficient to avoid RBC transfusion
• Prescriber is a specialist (e.g., nephrologist, oncologist) or has consulted with one
• Patient has no FDA labeled contraindications

Approval duration

varies by indication: 3 months (BCBSNM surgery); 1 month (other plans, surgery); 6 months (chemotherapy anemia, other diagnoses); 12 months (CKD, MDS, HIV anemia)