Neupogen — CareFirst (Caremark)
CAR T-cell-related toxicities (supportive care for neutropenic patients)
Initial criteria
- Authorization of 6 months may be granted for members with listed indications
- Members must meet relevant clinical criteria associated with the specified indication
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all initial authorization criteria
Approval duration
6 months