| 735 | For the treatment of patients with iron deficiency anemia (IDA) who meets ALL the following criteria:
- Patient has documented diagnosis of IDA confirmed by laboratory testing results (e.g. hemoglobin, ferritin); AND
- Patient has experienced a failure to respond, documented intolerance, or contraindication to an adequate trial (i.e. at least 4 weeks) of at least one oral iron therapy; AND
- Patient does not have hemochromatosis or other iron storage disorders; AND
- The iron formulation is administered in a setting where appropriate monitoring and management of hypersensitivity reactions can be provided to the patient. |
| | LU Authorization Period: 1 year |
| 736 | For the treatment of iron deficiency in patients with heart failure where ALL the following criteria apply:
1. Patient is 18 years of age or older; AND
2. Patient has heart failure with New York Heart Association (NYHA) class II or III; AND
3. Patient has a left ventricular ejection fraction (LVEF) less than or equal to 40% determined by echocardiography; AND
4. Patient has a ferritin level less than or equal to 300mcg/L with a transferrin saturation (TSAT) less than 15%; AND
5. The iron formulation is prescribed by a cardiologist or prescriber with expertise in the management of chronic heart failure. |
| | LU Authorization Period: 6 Months |
