Ferriprox (deferiprone) — Blue Cross Blue Shield of Texas

Initial criteria

• ONE of: (A) diagnosis of transfusional iron overload with thalassemia syndromes, OR (B) transfusional iron overload with sickle cell disease or other anemias AND patient does NOT have myelodysplastic syndrome AND does NOT have Diamond Blackfan anemia, OR (C) other FDA approved indication, OR (D) indication supported in compendia
• Absolute neutrophil count (ANC) ≥1.5 x 10^9/L
• If FDA approved indication, patient's age within FDA labeling or supported for use with that age
• If brand agent, ONE of: (A) metastatic cancer use defined, (B) currently stable on requested agent, (C) tried and inadequate response to generic, (D) discontinued generic due to adverse event, etc. per brand/generic criteria (same logic as deferasirox section)