Erythropoiesis Stimulating Agents
Prior authorization and coverage criteria for erythropoiesis stimulating agents (Aranesp/darbepoetin alfa; Epogen/epoetin alfa; Procrit/epoetin alfa; Retacrit/epoetin alfa-epbx) when provided via the medical benefit to Mass General Brigham Health Plan members, including approved diagnoses, initial and continuation criteria, limitations and authorization durations.
Policy updated to better reflect agents with prior authorization on medical benefit and Mircera removed as it was available on medical benefit without prior authorization.
Performed annual medical criteria review and updated agents requiring prior authorization on medical benefit.
Clarified criteria for members with CRF who were stable on an ESA previously (not a new member and no previous approval on file) with higher Hb levels must meet initial criteria.
Separated Rx vs medical benefit policies and removed preferred product requirement for requests under medical benefit.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.