Description: Ferumoxytol, non-esrd
Unit: 1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• Two doses of 510mg IV 3-8 days apart
Calculate drug reimbursement
(ASP: $242.01, Margin: $14.52)
# Units to bill:510
Prior auth criteria for Feraheme may include but is not limited to:
1. Patient must have laboratory evidence of iron deficiency anemia, defined as:
a. Hemoglobin ?10 g/dL
b. Serum ferritin <100 ng/mL
c. Transferrin saturation (TSAT) <20%
2. Patient has failed or cannot tolerate oral iron therapy.
3. Patient has been evaluated for other causes of anemia.
4. Patient is 18 years of age or older.
5. Patient is not pregnant, breastfeeding, or planning to become pregnant.
6. Patient is not receiving, or planning to receive, intravenous (IV) iron therapy within 4 weeks.
7. The prescriber has completed a Safety Information and Adverse Event Reporting Form (SIAERF).
Insurance prior auth guidelines:
Feraheme (AMAG PHARMACEUTICALS, INC.)