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.
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.