Hematology Medications

Each medication is FDA-approved for its own conditions:

• Iron deficiency and iron deficiency anemia: Injectafer (ferric carboxymaltose), Venofer (iron sucrose), Feraheme (ferumoxytol), INFeD (iron dextran) and Ferrlecit (sodium ferric gluconate complex in sucrose), all given intravenously; INFeD can also be injected into a muscle. Venofer is approved only for patients with chronic kidney disease, and Ferrlecit only for those on hemodialysis.
• Anemia: Epogen (epoetin alfa), also sold as Procrit, given by subcutaneous injection or intravenously, for anemia caused by chronic kidney disease, by chemotherapy or by the HIV medicine zidovudine, and to lower the need for red blood cell transfusions around some planned surgery.
• Low white blood cell counts (neutropenia): Neupogen (filgrastim), given by subcutaneous injection or intravenously, for severe chronic neutropenia (congenital, cyclic or idiopathic), for low counts after induction or consolidation chemotherapy for acute myeloid leukemia (AML), after a bone marrow transplant, and to move a patient's own stem cells into the blood for collection. Neupogen and Neulasta (pegfilgrastim) are both approved to lower the chance of infection when chemotherapy for a non-myeloid cancer often causes febrile neutropenia (low white blood cells with fever).
• Immune thrombocytopenia (ITP): intravenous immune globulin (IVIG), to raise platelet counts: Gamunex-C and Gammaked for adults and children; Gammagard S/D, Octagam 10% and Panzyga for adults with chronic ITP; and Privigen for chronic ITP from age 15.
• Hemophilia A and von Willebrand disease: desmopressin (DDAVP), given intravenously or subcutaneously by a healthcare professional, for bleeding with surgery and for bleeding episodes in hemophilia A with factor VIII activity above 5%, and in mild to moderate type 1 von Willebrand disease.
• Deep vein thrombosis (DVT): enoxaparin (Lovenox), a low molecular weight heparin given by subcutaneous injection, to prevent DVT with abdominal surgery, hip or knee replacement or an acute illness that limits mobility, and, with warfarin, to treat an acute DVT.
• PNH and atypical hemolytic uremic syndrome (aHUS): Soliris (eculizumab) and Ultomiris (ravulizumab-cwvz), complement inhibitors given intravenously. Both are available only through a REMS safety program; MedRx Infusion is certified to dispense them.
• Warm autoimmune hemolytic anemia (wAIHA): Imaavy (nipocalimab-aahu), given intravenously, for patients 12 years and older who are taking or have taken corticosteroids.

The full list, with a page for each medication, follows at the end of this page.

When the prescriber approves home therapy, MedRx sends a skilled, trusted and licensed nurse from an accredited nursing agency to give an infusion, such as IVIG for ITP, and to monitor vital signs and adverse reactions throughout.

Epogen, Neupogen, enoxaparin and Neulasta's prefilled syringe are subcutaneous injections that the patient or a caregiver can give after training; a nurse can teach the technique. The prescriber decides when a patient can start giving enoxaparin at home; its intravenous use is a single injection given in a hospital.

Some medications have limits of their own:

• Desmopressin is given by a healthcare professional, and Neulasta's on-body injector is applied by one.
• Feraheme and INFeD: the labels require staff and treatment for serious allergic reactions to be ready, and INFeD's label also calls for a small test dose first. Ferrlecit is given during hemodialysis sessions. The prescriber determines where they are given.

1. The prescriber's office phones (844) 671-2600 or faxes in the prescription with recent clinical notes and laboratory results. For IV iron, use the Iron infusion referral form (PDF); for hemophilia and von Willebrand disease, the Hemophilia referral form (PDF); for the other medications, the form listed on Quick Referral.
2. MedRx's intake team checks the patient's benefits and obtains any prior authorization the plan requires.
3. The medication and the supplies for it are delivered to the patient's door at no charge. Next-day delivery is available; timing varies by location.
4. For an infusion, a skilled, trusted and licensed nurse from an accredited nursing agency gives it at home; for a self-injected medication, a nurse can show the patient or a caregiver how.
5. A MedRx pharmacist is available 24 hours a day, 7 days a week, for questions about the medication.

Health plans often require prior authorization for hematology medications such as immune globulin, complement inhibitors and blood cell growth factors. MedRx's intake team checks coverage and handles the paperwork with the prescriber's office before the first delivery.

Where out-of-pocket costs are a barrier, MedRx helps patients find and apply for copay assistance, grants and other financial aid. Several manufacturers run programs for eligible patients, such as Amgen SupportPlus for Epogen, Neupogen and Neulasta, and Alexion OneSource for Soliris and Ultomiris; each medication page names its program.

• Iron deficiency: Injectafer, Venofer, Ferumoxytol, INFeD and Ferrlecit.
• Low blood counts: Epogen, Neupogen and Neulasta.
• Immune thrombocytopenia (ITP): Gamunex-C, Gammagard Liquid, Octagam, Panzyga and Privigen.
• Clotting and bleeding disorders: Enoxaparin and Desmopressin.
• PNH, aHUS and warm autoimmune hemolytic anemia: Soliris, Ultomiris and Imaavy.

Each has its own page: what it is approved for, how it is given, and how to start. See every medication we fill.