Effective November 1, 2022, the following long-acting colony-stimulating factors are designated as preferred products for members enrolled in AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively AmeriHealth New Jersey), AmeriHealth HMO, Inc. (AmeriHealth Pennsylvania), and AmeriHealth Administrators programs:
- Fulphila® (pegfilgrastim-jmdb)
- Neulasta® (pegfilgrastim)
- Ziextenzo® (pegfilgrastim-bmez)
All other long-acting colony-stimulating factors are considered nonpreferred, including:
- Fylnetra® (pegfilgrastim-pbbk)
- Nyvepria® (pegfilgrastim-apgf)
- Rolvedon™ (eflapegrastim-xnst)
- Stimufend® (pegfilgrastim-fpgk)
- Udenyca® (pegfilgrastim-cbqv)
The following medical policy is being updated to address these preferred and nonpreferred designations: