Retacrit — CareFirst (Caremark)
Anemia in myelodysplastic syndrome (MDS)
Initial criteria
- Pretreatment hemoglobin less than 10 g/dL
- 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