Retacrit — Medica

Anemia in a patient with human immunodeficiency virus who is receiving zidovudine

Initial criteria

Patient meets ONE of the following (A or B):
A) Initial Therapy. Approve if ALL of the following (i, ii, iii):
i. ONE of the following: a) hemoglobin < 10.0 g/dL; OR b) serum erythropoietin level ≤ 500 mU/mL; AND
ii. Patient is currently receiving zidovudine; AND
iii. ONE of the following: a) currently receiving iron therapy; OR b) has adequate iron stores per prescriber;
B) Patient currently receiving an erythropoiesis-stimulating agent and ALL of the following (i, ii, iii):
i. Hemoglobin ≤ 12.0 g/dL; AND
ii. Currently receiving zidovudine; AND
iii. ONE of the following: a) currently receiving iron therapy; OR b) has adequate iron stores per prescriber.

1 year