Filgrastim (Neupogen, Nivestrym, Zarxio)

Filgrastim (Neupogen, Nivestym, Zarxio) is covered only for specified non‑oncology indications — symptomatic congenital, cyclic, or idiopathic severe chronic neutropenia (FDA‑approved), HIV/AIDS‑associated neutropenia, and drug‑induced (non‑chemotherapy) agranulocytosis/neutropenia — and uses outside these listed FDA‑approved or compendial indications are not covered. Approvals are time‑limited and require documentation and appropriate prescriber/consultation specialty: severe chronic neutropenia ≤6 months if prescribed/consulted by a hematologist (≤12 mcg/kg/day SC); HIV/AIDS ≤4 months if prescribed/consulted by an infectious disease/hematology/HIV specialist (≤10 mcg/kg/day SC); drug‑induced neutropenia ≤1 month (≤10 mcg/kg/day SC), with documentation of diagnosis, dosing (mcg/kg/day), route (subcutaneous), and etiology as applicable.

" - Drug-induced (non-chemotherapy) agranulocytosis or neutropenia: Approve up to 10 mcg/kg per day as a subcutaneous injection."