Nypozi (filgrastim-aafi) — CareFirst (Caremark)
Chronic Myeloid Leukemia with persistent neutropenia due to tyrosine kinase inhibitor therapy
Preferred products
- Neupogen
- Zarxio
- Nivestym
- Granix
- Releuko
Initial criteria
- Diagnosis is an FDA-approved or medically accepted indication as listed above
- Used for prevention or treatment of neutropenia or febrile neutropenia associated with chemotherapy or other listed conditions
- For prophylaxis: patient receiving myelosuppressive chemotherapy regimen with ≥20% risk of febrile neutropenia or regimen with 10–19% risk plus at least one patient risk factor (per Appendix A–C)
- For treatment: member has neutropenia complicated by infection (e.g., sepsis syndrome, invasive fungal infection, pneumonia or other documented infection), prolonged or profound neutropenia, or history of febrile neutropenia
- Prescriber is an oncologist, hematologist, or infectious disease specialist or under their supervision
Reauthorization criteria
- Member continues to meet initial authorization criteria
- Clinical benefit is demonstrated with continued therapy
Approval duration
6 months