Granix — CareFirst (Caremark)
Treatment for radiation-induced myelosuppression following a radiological/nuclear incident
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