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

Filgrastim (Neupogen®, Nivestym™, Nypozi™, Releuko®, Zarxio®) is covered only for specified non‑oncology indications—symptomatic congenital, cyclic, or idiopathic neutropenia (FDA‑approved), HIV/AIDS‑associated neutropenia, and drug‑induced (non‑chemotherapy) agranulocytosis/neutropenia—and other nonlisted uses are excluded. Coverage requires indication-specific documentation, prescriber specialty/consultation (hematologist for severe chronic neutropenia; infectious disease/HIV specialist or hematologist for HIV/AIDS), specified approval durations (6 months for severe chronic neutropenia, 4 months for HIV/AIDS, 1 month for drug‑induced), and weight‑based subcutaneous dosing limits (up to 12 mcg/kg/day for severe chronic neutropenia; up to 10 mcg/kg/day for the other covered uses).

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