Retacrit — CareFirst (Caremark)
Anemia due to cancer (palliative treatment)
Initial criteria
- Member has cancer undergoing palliative treatment
- Member assessed for iron deficiency anemia and has adequate iron stores (TSAT ≥ 20% within prior 3 months) or is receiving iron therapy
- Member not using other erythropoiesis-stimulating agents concomitantly
Reauthorization criteria
- After at least 12 weeks of ESA treatment, member must show a rise in hemoglobin ≥ 1 g/dL to continue therapy
- Current hemoglobin < 12 g/dL
Approval duration
12 weeks