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Epogen — Medica

Anemia due to zidovudine-treated HIV infection

Initial criteria

  • Patient has a hemoglobin < 10.0 g/dL OR a serum erythropoietin level ≤ 500 mU/mL
  • Patient is currently receiving zidovudine therapy
  • Patient is currently receiving iron therapy OR has adequate iron stores according to the prescriber

Reauthorization criteria

  • Patient has a hemoglobin ≤ 12.0 g/dL
  • Patient is currently receiving zidovudine therapy
  • Patient is currently receiving iron therapy OR has adequate iron stores according to the prescriber