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Epogen — Medica

Anemia in a patient with cancer due to cancer chemotherapy

Initial criteria

  • ALL of the following: (i) hemoglobin < 10.0 g/dL; AND (ii) BOTH of the following: (a) currently receiving myelosuppressive chemotherapy; AND (b) according to the prescriber, myelosuppressive chemotherapy is considered non-curative; AND (iii) ONE of the following: (a) currently receiving iron therapy; OR (b) has adequate iron stores according to the prescriber

Reauthorization criteria

  • ALL of the following: (i) hemoglobin ≤ 12.0 g/dL; AND (ii) BOTH of the following: (a) currently receiving myelosuppressive chemotherapy; AND (b) according to the prescriber, myelosuppressive chemotherapy is considered non-curative; AND (iii) ONE of the following: (a) currently receiving iron therapy; OR (b) has adequate iron stores according to the prescriber

Approval duration

6 months