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Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506
A59661
National Government Services, Inc. (J06)
Effective: February 1, 2024
Updated: December 31, 2025
Policy Summary
Pegfilgrastim is covered for prophylaxis of febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy that carries a clinically significant risk of febrile neutropenia, and should be administered per the FDA-approved schedule (starting ≥24 hours after chemotherapy). Routine same-day (same-day as chemotherapy) administration is not recommended, but may be considered as an exception when clear documentation shows significant patient/caregiver barriers to returning for next-day dosing.
Coverage Criteria Preview
Key requirements from the full policy
"Pegfilgrastim is covered for prophylaxis to decrease the incidence of infection (manifested by febrile neutropenia) in patients with nonmyeloid malignancies receiving myelosuppressive cancer chemot..."
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