Traditional MedicarePrior AuthMedium impact
Aranesp® (darbepoetin alfa) (Revised)
Humana·SC · Nephrology, Oncology, Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana revised their Aranesp (darbepoetin alfa) prior authorization policy effective January 1, 2025, for Medicare and South Carolina Medicaid plans. The policy establishes specific clinical criteria and step therapy requirements for treating anemia in chronic kidney disease, chemotherapy-treated cancer patients, and myelodysplastic syndromes.
Action Required
Immediately: Review current Aranesp prescriptions to ensure compliance with new prior authorization criteria. Billing team must verify patients meet specific hemoglobin/hematocrit thresholds, iron store requirements, and step therapy requirements (failed Retacrit for Part D or Retacrit/Procrit for Part B) before submitting claims. Update prior authorization request forms to include required lab values and document inadequate response to first-line ESA therapy. Claims without proper prior authorization will be denied.