Comprehensive medication guide to Retacrit including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$150/month copay when covered under commercial insurance as a preferred ESA; often $0–20% coinsurance under Medicare Part B for dialysis and provider-administered settings. Prior authorization required.
Estimated Cash Pricing
$228–$2,216+ per vial depending on strength (2,000 to 20,000 Units/mL); a 40,000 Units/mL vial retails ~$560, with discount cards reducing this to ~$442. Monthly costs vary widely based on prescribed dose.
Medfinder Findability Score
65/100
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Retacrit (epoetin alfa-epbx) is a biosimilar erythropoiesis-stimulating agent (ESA) approved by the FDA on May 15, 2018. It was the first biosimilar ESA approved in the United States and is manufactured by Hospira, a Pfizer company. Retacrit is biosimilar to Epogen and Procrit (both epoetin alfa) and has been shown to have no clinically meaningful differences from these reference products.
Retacrit is FDA-approved to treat anemia due to chronic kidney disease (CKD) in patients on and off dialysis, anemia from zidovudine (AZT) treatment in HIV-positive patients, anemia from myelosuppressive chemotherapy in cancer patients, and to reduce the need for blood transfusions in elective noncardiac, nonvascular surgery patients.
Retacrit is available as an injectable solution in single-dose vials (2,000, 3,000, 4,000, 10,000, and 40,000 Units/mL) and multi-dose vials (20,000 Units/mL, which contain benzyl alcohol). It is given intravenously (IV) or subcutaneously (SC) and requires refrigeration at 2°C–8°C.
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Retacrit is a recombinant human erythropoietin — a laboratory-engineered copy of the natural hormone produced by the kidneys. In healthy individuals, erythropoietin is released by the kidneys when oxygen levels in the blood drop, signaling the bone marrow to produce more red blood cells.
When Retacrit is injected, it travels through the bloodstream to the bone marrow, where it binds to erythropoietin receptors on red blood cell precursor cells. This binding activates the JAK2/STAT5 signaling pathway, triggering the cells to proliferate, mature, and be released into the bloodstream as red blood cells. Over 2–6 weeks, hemoglobin levels rise and anemia symptoms improve.
Retacrit requires adequate iron stores to work effectively — if iron is deficient, the bone marrow cannot produce hemoglobin at the rate Retacrit stimulates. Iron supplementation is often co-prescribed. Careful dose titration is essential because hemoglobin that rises above 11 g/dL (in CKD patients) increases cardiovascular risk — the FDA boxed warning requires using the lowest effective dose.
2,000 Units/mL — Single-dose vial (1 mL)
Preservative-free. IV or SC injection.
3,000 Units/mL — Single-dose vial (1 mL)
Preservative-free. IV or SC injection.
4,000 Units/mL — Single-dose vial (1 mL)
Preservative-free. IV or SC injection.
10,000 Units/mL — Single-dose vial (1 mL)
Preservative-free. IV or SC injection.
40,000 Units/mL — Single-dose vial (1 mL)
Preservative-free. IV or SC injection.
20,000 Units/2 mL (10,000 Units/mL) — Multiple-dose vial
Contains benzyl alcohol. Contraindicated in neonates, infants, pregnant and lactating women.
20,000 Units/mL — Multiple-dose vial
Contains benzyl alcohol. Contraindicated in neonates, infants, pregnant and lactating women.
Retacrit is a specialty biologic injectable that is not stocked at standard retail pharmacies. It is dispensed through specialty pharmacies (CVS Specialty, Walgreens Specialty Pharmacy, Accredo, Optum) or administered directly in dialysis centers and oncology infusion clinics. This narrow distribution network means that even when no national shortage is declared, localized supply gaps for specific vial strengths are common.
Retacrit experienced significant supply disruptions in Q2–Q4 2022 and again in September 2023. As of mid-2025, ASHP confirmed that Pfizer has Retacrit available nationally with no active shortage declaration. However, Retacrit's findability score reflects the ongoing challenge of locating specific vial strengths at specialty pharmacies and the lack of retail pharmacy stocking.
If you're having trouble finding Retacrit, medfinder calls specialty pharmacies near you to check which ones have your specific Retacrit strength in stock — saving you hours of hold time.
Retacrit is not a controlled substance, so there are no DEA-specific prescribing restrictions. Any licensed prescriber with prescribing authority may write a Retacrit prescription. However, because Retacrit requires regular lab monitoring (hemoglobin, iron studies), prior authorization from insurance, and specialty pharmacy dispensing, it is almost always managed by specialists.
Telehealth has a limited role in Retacrit management. While follow-up consultations and lab reviews can occur via telehealth, the initial prescription requires in-person evaluation with physical lab work. Most patients receive Retacrit administered at a dialysis or infusion center, not through telehealth-initiated home delivery.
No. Retacrit (epoetin alfa-epbx) is not a controlled substance and is not scheduled by the Drug Enforcement Administration (DEA) under any schedule. There are no DEA-specific prescribing restrictions — any licensed prescriber with prescribing authority can write a Retacrit prescription.
While it is not controlled, Retacrit does require a valid prescription and prior authorization from most insurance plans. It is a specialty biologic with REMS (Risk Evaluation and Mitigation Strategy) considerations under the FDA Boxed Warning. Prescribers must document appropriate clinical indications (hemoglobin thresholds, iron stores) and ensure patients receive required monitoring labs during treatment.
The most frequently reported side effects in CKD patients include:
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Epogen (epoetin alfa)
Brand-name reference product by Amgen. Same active ingredient and indications as Retacrit. Widely used in dialysis settings. Not interchangeable with Retacrit without prescriber authorization. Generally more expensive than Retacrit.
Procrit (epoetin alfa)
Brand-name reference product by Janssen. Same active ingredient and indications. Common in oncology settings. Contains human albumin (Retacrit does not). Requires new prescription to switch.
Aranesp (darbepoetin alfa)
Longer-acting ESA by Amgen. Approved for CKD and chemotherapy anemia (not HIV or surgery). Dosed weekly to every 3 weeks. Requires dose conversion (~200 Units/week epoetin alfa ≈ 1 mcg/week darbepoetin alfa).
Mircera (methoxy PEG-epoetin beta)
Continuous erythropoietin receptor activator. CKD anemia only. Monthly or biweekly dosing — most convenient ESA for stable patients. Not approved for chemotherapy or HIV anemia.
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Lenalidomide (Revlimid)
majorSignificantly increases risk of venous thromboembolism (DVT/PE) when combined with ESAs. Prophylactic anticoagulation (aspirin or LMWH) typically required.
Thalidomide
majorIncreased risk of deep vein thrombosis and pulmonary embolism when combined with ESAs. Blood clot prevention required.
Pomalidomide (Pomalyst)
majorAnother thalidomide analog; similar thrombosis-amplifying effect with ESAs. Monitor closely and use prophylactic anticoagulation.
Antihypertensives (ACE inhibitors, ARBs, beta-blockers, CCBs)
moderateRetacrit commonly raises blood pressure; antihypertensive doses may need adjustment as anemia improves. ~25% of dialysis patients need new or increased antihypertensive therapy.
Cyclosporine
moderateAs hematocrit rises with ESA therapy, cyclosporine blood levels may change due to altered protein binding. Monitor cyclosporine levels in transplant patients.
Androgens (testosterone)
moderateMay enhance erythropoietic effect of Retacrit, causing hemoglobin to rise more rapidly or higher than intended. Monitor hemoglobin closely.
Iron supplements / IV iron
minorRequired co-therapy rather than a negative interaction. Iron supplementation ensures adequate iron stores (ferritin ≥100 ng/mL, TSAT ≥20%) for Retacrit to work optimally.
Retacrit (epoetin alfa-epbx) is a well-established, FDA-approved biosimilar that has brought greater access and lower costs to ESA therapy for patients with CKD, cancer-related anemia, HIV-related anemia, and surgical anemia. It is now the preferred ESA on many commercial formularies and is generally widely available — though its specialty supply chain means stock gaps can arise, particularly for specific vial strengths.
Patients on Retacrit should maintain regular lab monitoring appointments, manage blood pressure proactively, and always communicate with their prescriber before stopping or changing their dose. The drug is most effective when combined with adequate iron supplementation and used at the lowest effective dose.
If you're struggling to find Retacrit at your specialty pharmacy, medfinder can help — the service calls pharmacies near you to check which ones can fill your specific Retacrit prescription, saving you hours of hold time and repeated calls.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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