90935 Insurance Policy Changes

Daprodustat (Jesduvroq) (CPB 1044, reviewed 2026-01-27)

Aetna has established new coverage criteria for daprodustat (Jesduvroq), an oral medication for anemia in dialysis patients with CKD. The policy requires: (1) patients must have received dialysis for at least 4 months with pretreatment hemoglobin ≤11 g/dL for initial approval, (2) adequate iron stores (TSAT ≥20%) or concurrent iron therapy, and (3) no concurrent use with ESAs. All other indications are considered experimental. This is the first time Aetna has formally established coverage for this newly FDA-approved medication (February 2023).