Filgrastim (Neupogen® , Nivestym™, Zarxio®, Releuko®) Non-oncology

Covered only for non‑oncology symptomatic severe chronic neutropenia (congenital, cyclic, idiopathic), HIV/AIDS‑associated neutropenia, and drug‑induced (non‑chemotherapy) agranulocytosis/neutropenia; all other indications are not covered. Approvals are time‑limited (6 months for severe chronic, 4 months for HIV/AIDS, 1 month for drug‑induced), require specialty prescribing/consultation (hematologist for chronic; infectious disease/hematology/HIV specialist for HIV), documentation of diagnosis and symptoms as indicated, adherence to dosing limits (≤12 mcg/kg/day for severe chronic; ≤10 mcg/kg/day for HIV and drug‑induced), and meeting applicable safety criteria.

"Chronic administration to reduce the incidence and duration of sequelae of neutropenia (e."

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