Aranesp — Point32Health

Initial criteria

• Documentation of one (1) of the following:
• a. All of the following: i. Prescribed for the treatment of anemia due to chronic kidney disease, in a patient whose religious beliefs forbid blood transfusions, or due to cancer in a patient receiving palliative treatment AND ii. Patient has a documented pre-treatment hemoglobin level less than 10 g/dL AND iii. Adequate iron stores (serum transferrin saturation ≥ 20% within prior 3 months or currently receiving iron therapy)
• OR b. All of the following: i. Prescribed for the treatment of anemia due to primary myelofibrosis, post-polycythemia vera myelofibrosis, post essential thrombocytopenia myelofibrosis, or myelodysplastic syndrome AND ii. Pre-treatment serum erythropoietin level < 500 mU/mL AND iii. Patient has a documented pre-treatment hemoglobin < 10 g/dL AND iv. Adequate iron stores (serum transferrin saturation ≥ 20% within prior 3 months or currently receiving iron therapy)
• OR c. Both of the following: i. Prescribed for the treatment of anemia due to a malignancy AND ii. Adequate iron stores (serum transferrin saturation ≥ 20% within prior 3 months or currently receiving iron therapy)