Filgrastim (Neupogen, Nivestym, Zarxio, Releuko)

Covers filgrastim for specified non‑oncology uses — chronic symptomatic severe neutropenias (congenital, cyclic, idiopathic), HIV/AIDS‑associated neutropenia, and non‑chemotherapy drug‑induced agranulocytosis/neutropenia — and excludes oncology indications. Approvals require an FDA‑approved or compendial indication with documentation, specialist prescribing or consultation, are time‑limited (6 months for severe chronic neutropenia, 4 months for HIV/AIDS, 1 month for drug‑induced), and limit dosing to ≤12 mcg/kg/day for severe chronic neutropenia and ≤10 mcg/kg/day for HIV/AIDS and drug‑induced cases.

"When requesting filgrastim (Neupogen, Nivestym, Zarxio, Releuko) for non-oncology indications, the individual requiring treatment must be diagnosed with an FDA-approved indication or approved compe..."

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