Granix — CareFirst (Caremark)
Glycogen Storage Disease (GSD) Type 1 for treatment of low neutrophil counts
Preferred products
- Neupogen
- Zarxio
- Nivestym
- Releuko
- Nypozi
Initial criteria
- Member has one of the listed covered indications
- Clinical documentation supports neutropenia or indication as described
Reauthorization criteria
- All members (including new members) requesting continuation of therapy must meet all initial authorization criteria
Approval duration
6 months