Filgrastim (Neupogen, Nivestrym, Zarxio)

Filgrastim (Neupogen, Nivestym, Zarxio) is covered only for FDA‑approved non‑oncology indications — symptomatic congenital, cyclic, and idiopathic neutropenia — and the compendial off‑label use of zidovudine‑associated neutropenia in HIV; other uses and patients with a history of serious pegfilgrastim allergy are excluded. Coverage requires documented diagnosis, exclusion of other causes of chronic neutropenia, documentation of no serious pegfilgrastim allergy, ANC monitoring with individualized dosing (starting doses provided), and approvals are limited to 12 months for initial and renewal requests.

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

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