Erythropoietin (EPO)

50.5.2 - Erythropoietin (EPO) (Rev. 1, 10-01-03) A3-3112.4.B.4, HO-230.4.B.4 The statute provides that EPO is covered for the treatment of anemia for patients with chronic renal failure who are on dialysis. Coverage is available regardless of whether the drug is administered by the patient or the patient’s caregiver. EPO is a biologically engineered protein which stimulates the bone marrow to make new red blood cells. NOTE: Non-ESRD patients who are receiving EPO to treat anemia induced by other conditions such as chemotherapy or the drug zidovudine (commonly called AZT) must meet the coverage requirements in §50. EPO is covered for the treatment of anemia for patients with chronic renal failure who are on dialysis when: • It is administered in the renal dialysis facility; or • It is self-administered in the home by any dialysis patient (or patient caregiver) who is determined competent to use the drug and meets the other conditions detailed below. NOTE: Payment may not be made for EPO under the incident to provision when EPO is administered in the renal dialysis facility. Also, in the office setting, reimbursement will be made for the administration charge only for non-ESRD patients receiving EPO.