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Procrit — Blue Cross Blue Shield of Texas

Anemia associated with Hepatitis C in patients treated with ribavirin and interferon alfa or peginterferon

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)