Traditional MedicarePrior AuthMedium impact
Epoetin Alfa (Epogen, Procrit, Retacrit) (Revised)
Humana·SC, VA · Nephrology, Hematology, Oncology +1 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Epoetin Alfa medications (Epogen, Procrit, Retacrit) effective January 1, 2025. The policy establishes specific criteria for coverage of anemia treatments including hemoglobin thresholds, iron store requirements, and preferred product hierarchies that vary by Medicare Part B vs Part D coverage.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirements for Epoetin Alfa (Epogen, Procrit, Retacrit) injections. Update billing system to require documentation of hemoglobin levels, iron studies (transferrin saturation ≥20% OR ferritin ≥100 ng/mL), and exclusion of other anemia causes. For Medicare Part B, use Retacrit or Procrit as preferred products; for Medicare Part D, use Retacrit as preferred. Claims without proper prior authorization will be denied.