Nivestym — CareFirst (Caremark)
Severe chronic neutropenia (congenital, cyclic, or idiopathic)
Preferred products
- Neupogen
- Granix
- Zarxio
- Releuko
- Nypozi
Initial criteria
- Member has one of the listed indications (1 through 13).
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all initial authorization criteria.
Approval duration
6 months