Pegfilgrastim injection (Neulasta)

Neulasta (pegfilgrastim) is covered only for FDA‑approved indications — prevention of febrile neutropenia in non‑myeloid malignancies (including solid tumors or AML in post‑remission treatment) receiving myelosuppressive chemotherapy and to increase survival after acute high‑dose radiation exposure — with no off‑label compendial uses supported and contraindicated in patients with a history of serious allergic reaction to filgrastim. Coverage requires documentation of the approved diagnosis and increased FN risk (hospitalization or dose‑limiting neutropenia on the current regimen; or high‑risk chemo ≥20%; or intermediate‑risk chemo 10–19% plus ≥1 specified risk factor), confirmation dosing is not given between 14 days before and 24 hours after cytotoxic chemotherapy, and approvals are limited to 180 days.

"Planned or expected duration of therapy consistent with approval duration (initial and renewal): 180 days"