CommercialCoverageMedium impact
Update to Epoetin Alfa Product Coverage
Medical Mutual of Ohio·Oncology, Hematology, Nephrology +2 more·In the News
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Effective January 1, 2019, Medical Mutual plans will require a trial of preferred epoetin alfa product Retacrit before covering non-preferred products Procrit and Epogen. This creates a step therapy requirement for erythropoiesis-stimulating agents used to treat anemia.
Action Required
Before January 1, 2019: Billing team must update Medical Mutual Commercial and ACA plan authorization processes to require trial of Retacrit before prescribing Procrit or Epogen for epoetin alfa treatments. Providers should be notified to prescribe Retacrit as first-line therapy for new anemia patients. Claims for non-preferred products without documented trial of preferred product may be denied.