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Pegfilgrastim (Neulasta®) and related biosimilars coverage criteria changes

November 10, 2021

Effective February 7, 2022, Independence will update coverage criteria for:

  • pegfilgrastim (Neulasta®)
  • pegfilgrastim-apgf (Nyvepria™​)
  • pegfilgrastim-bmez (Ziextenzo®)
  • pegfilgrastim-cbqv (Udenyca®)
  • pegfilgrastim-jmdb (Fulphila®)

The changes align with the current recommendations from drug compendia, such as The National Comprehensive Cancer Network (NCCN) and Professional Guidelines from the American Society of Clinical Oncology: Recommendations for the Use of WBC Growth Factors.

Commercial and Medicare Advantage Policy Notifications were posted November 9, 2021:

  • #08.01.32f: Pegfilgrastim (Neulasta®) and related biosimilars
  • #MA08.082f: Pegfilgrastim (Neulasta®) and related biosimilars

The policy changes include the removal of criteria for individuals with these conditions:

  • Prophylaxis of chemotherapy-induced febrile neutropenia (regardless of risk status) in individuals with acute myeloid leukemia (AML) who are septic and have a life-threatening infection, when receiving induction chemotherapy.
  • Intermittent use in individuals with myelodysplastic syndromes (MDS) who have severe neutropenia and recurrent infection.

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