Procrit — Medica

Initial criteria

• Patient has a hemoglobin < 10.0 g/dL OR a serum erythropoietin level ≤ 500 mU/mL
• Patient is currently receiving iron therapy OR has adequate iron stores according to the prescriber
• Medication is prescribed by or in consultation with a hematologist or oncologist

Reauthorization criteria

• Patient has a hemoglobin ≤ 12.0 g/dL
• Patient is currently receiving iron therapy OR has adequate iron stores according to the prescriber
• According to the prescriber, patient has responded to therapy defined as hemoglobin ≥ 10 g/dL or a hemoglobin increase of ≥ 2 g/dL
• Medication is prescribed by or in consultation with a hematologist or oncologist

Approval duration

Initial: 3 months; Reauth: 1 year