Hematopoietic Colony-Stimulating Factors (CSFs)

Short-acting G‑CSFs are covered as medically necessary for prevention or treatment of febrile neutropenia in cancer patients on myelosuppressive chemotherapy when policy criteria are met (primary prophylaxis for regimens with FN risk ≥20%, for 10–19% risk if patient is high‑risk, for <10% risk with ≥2 patient risk factors, and secondary prophylaxis after prior FN or dose‑limiting neutropenia if the same regimen/dose is planned). Key requirements/limitations: CSFs must not be combined with other colony‑stimulating factors in the same cycle, should be avoided with concomitant chemo+radiation, and pegfilgrastim/pegylated products must follow label timing and scheduling limits (not with weekly or <14‑day chemotherapy cycles, on‑body injector delivers ≥24 hours after chemo, and not given between 14 days before and 24 hours after cytotoxic chemotherapy).

"Nyvepria (pegfilgrastim‑apgf) FDA-Approved Indication: same as Neulasta (pegfilgrastim) (biosimilar)."