Filgrastim (Neupogen, Nivestrym, Zarxio)

Filgrastim (Neupogen, Nivestym, Zarxio) is covered for non‑oncology use only for FDA‑approved or compendial indications — severe chronic neutropenia (congenital, cyclic, idiopathic), zidovudine‑associated neutropenia in HIV, and non‑chemotherapy drug‑induced agranulocytosis/neutropenia — and excluded for other off‑label uses. Approval is time‑limited (6 months for severe chronic neutropenia with hematologist involvement; 4 months for HIV‑related neutropenia with an ID/hematology/HIV specialist; 1 month for drug‑induced cases) and requires documentation of diagnosis, specialist prescription/consultation, baseline and follow‑up ANC, patient weight for mcg/kg dosing, and evidence of drug causation when applicable.

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