Granix (tbo-filgrastim) — CareFirst (Caremark)
Primary prophylaxis of febrile neutropenia in members with solid tumors or non-myeloid malignancies receiving myelosuppressive anti-cancer therapy expected to cause ≥20% risk of febrile neutropenia, or 10–19% risk with additional risk factors, or <10% risk with ≥2 patient-related risk factors
Initial criteria
- Authorization may be granted when all of the following are met:
- 1. The requested medication will not be used in combination with other colony stimulating factors within any chemotherapy cycle.
- 2. The member will not receive chemotherapy at the same time as radiation therapy.
- 3. One of the following applies:
- i. Primary prophylaxis: member is receiving myelosuppressive anti-cancer therapy expected to produce ≥20% risk of febrile neutropenia, or 10–19% risk with high-risk features (bone marrow compromise, comorbidities, other patient-specific risk factors), or <10% risk with at least 2 patient-related risk factors.
- ii. Secondary prophylaxis: member experienced febrile neutropenia or dose-limiting neutropenia from prior chemotherapy cycle with same dose and schedule planned for current cycle.
- iii. Treatment of high-risk febrile neutropenia: member has prognostic factors predictive of deterioration such as age >65 years or hospitalization at time of fever.
Approval duration
6 months