Intravenous Iron Replacement Therapy (Feraheme, Injectafer, & Monoferric)
Defines UnitedHealthcare medical necessity criteria for IV iron products Feraheme (ferumoxytol), Injectafer (ferric carboxymaltose), and Monoferric (ferric derisomaltose) for treatment of iron deficiency anemia in commercial and Medicare contexts; specifies covered indications, required documentation, and applicable codes.
Monoferric is not medically necessary for the treatment of any diagnosis addressed within this policy.
Removed specific dosage requirements for Feraheme and Injectafer and now refer to applicable U.S. FDA approved labeling.
Changed laboratory timing requirement for demonstrating treatment failure from 1-3 weeks post-dose to 4-12 weeks post-dose.
Replaced physician attestation language to require prescriber attestation that response to Feraheme or Injectafer would be expected to be superior to preferred IV iron products.
Extended acceptable timing for recent laboratory results for continuation therapy from within 4 weeks to within 4-12 weeks since last Feraheme or Injectafer administration.
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