Mircera — Blue Cross Blue Shield of Texas
Anemia associated with chronic kidney disease (including ESRD)
Initial criteria
- Prior to starting the requested agent, ferritin ≥ 100 ng/mL OR transferrin saturation ≥ 20%
- Iron stores maintained before and during ESA therapy
- Blood pressure adequately controlled before and during ESA therapy
- ESA dose is the lowest to avoid RBC transfusion need
- Prescriber is appropriate specialist or consulted with one
- Patient has no FDA labeled contraindications
Approval duration
12 months