Retacrit — CareFirst (Caremark)
Anemia due to cancer in patients undergoing palliative treatment
Initial criteria
- Cancer with palliative treatment intent
- Member assessed for iron deficiency anemia and has adequate iron stores (TSAT ≥ 20% within the prior 3 months) or receiving iron therapy
Reauthorization criteria
- Current hemoglobin less than 12 g/dL
- Documented response with rise in hemoglobin ≥ 1 g/dL after at least 12 weeks of therapy
Approval duration
12 weeks