Epogen — CareFirst (Caremark)
Reduction of allogeneic red blood cell transfusion in elective, noncardiac, nonvascular surgery
Initial criteria
- Scheduled to have elective, noncardiac, nonvascular surgery
- Pretreatment hemoglobin ≤ 13 g/dL and > 10 g/dL
- At high risk for perioperative blood loss
- Member assessed for iron deficiency anemia and has adequate iron stores (TSAT ≥ 20% within the prior 3 months) or receiving iron therapy
- May not use concomitantly with other erythropoiesis-stimulating agents
Reauthorization criteria
- Meets all initial authorization criteria
Approval duration
8 weeks