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Epogen — Medica

any indication meeting respective standard Erythropoiesis-Stimulating Agents Prior Authorization Policy criteria

Preferred products

  • Procrit
  • Retacrit

Initial criteria

  • Patient meets the respective standard Erythropoiesis-Stimulating Agents Prior Authorization Policy criteria
  • Patient has tried at least one Preferred Product (Procrit or Retacrit) OR meets exception criteria

Reauthorization criteria

  • Reauthorization per respective standard Erythropoiesis-Stimulating Agents Prior Authorization Policy criteria

Approval duration

3 years for chronic kidney disease on dialysis; otherwise per respective standard Erythropoiesis-Stimulating Agents Prior Authorization Policy