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Growth factors / Renal dialysis / Hemoglobins / Anemias / Erythropoietin / Epoetin alfa / Darbepoetin alfa / Thalassemia / Chemotherapy / Medicine / Hematology / Erythropoiesis-stimulating agents


Division: Pharmacy Services Subject: Prior Authorization Criteria Original Development Date: Original Effective Date:
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Document Date: 2012-06-25 13:42:39

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File Size: 288,56 KB

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Facility

Pharmacy Services Subject / /

MedicalCondition

chronic kidney disease / folate deficiency / Cancer / Anemia / /

MedicalTreatment

hemodialysis / dialysis / chemotherapy / /

Product

Aranesp / /

Technology

ESA / chemotherapy / dialysis / /

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