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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say effective December 1, 2000, Medicare covers sodium ferric gluconate complex in sucrose 
injection as a first line treatment of iron deficiency anemia when furnished intravenously to patients undergoing 
chronic hemodialysis who are receiving supplemental erythropoeitin therapy. Effective October 1, 2001, 
Medicare also covers iron sucrose injection as a first line treatment of iron deficiency anemia when furnished 
intravenously to patients undergoing chronic hemodialysis who are receiving supplemental erythropoeitin 
therapy. You can find this information in Medicare's National Coverage Determination (NCD): Intravenous 
Iron Therapy (110.10). 
 
The rules say ESA treatment for the anemia secondary to myelosuppressive anticancer chemotherapy in solid 
tumors, multiple myeloma, lymphoma, and lymphocytic leukemia is only reasonable and necessary under the 
following specified conditions: 
 
    The hemoglobin level immediately prior to initiation or maintenance of ESA treatment is less than 10 g/dL 
(or the hematocrit is less than 30%). 
    The starting dose for ESA treatment is the recommended FDA label starting dose, no more than 150 U/kg/3 
times weekly for epoetin and 2.25 mcg/kg/1 time weekly for darbepoetin alpha. Equivalent doses may be given 
over other approved time periods. 
    Maintenance of ESA therapy is the starting dose if the hemoglobin level remains below 10g/dL (or 
hematocrit is less than 30%) 4 weeks after initiation of therapy and the rise in hemoglobin is equals 1g/dL 
(hematocrit equals 3%); 
    For patients whose hemoglobin rises less than 1g/dl (hematocrit rise less than 3%) compared to pretreatment 
baseline over 4 weeks of treatment and whose hemoglobin level remains less than 10g/dL after the 4 weeks of 
treatment (or the hematocrit is less than 30%), the recommended FDA label starting dose may be increased 
once by 25%. Continued use of the drug is not reasonable and necessary if the hemoglobin rises less than 1g/dl 
(hematocrit rise less than 3%) compared to pretreatment baseline by 8 weeks of treatment. 
    Continued administration of the drug is not reasonable and necessary if there is a rapid rise in hemoglobin > 
1g/dl (hematocrit greater than 3%) over 2 weeks of treatment unless the hemoglobin remains below or 
subsequently falls to less than 10g/dL (or the hematocrit is less than 30%). Continuation and reinstitution of 
ESA therapy must include a dose reduction of 25% from the previously administered dose. 
    ESA treatment duration for each course of chemotherapy includes the 8 weeks following the final dose of 
myelosuppressive chemotherapy in a chemotherapy regimen. 
 You can find this information in Medicare's National Coverage Determination (NCD): Erythropoiesis 
Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.