Zarxio — CareFirst (Caremark)
Glycogen Storage Disease (GSD) Type 1 (low neutrophil counts)
Preferred products
- Neupogen
- Nivestym
- Granix
- Releuko
- Nypozi
Initial criteria
- Authorization of 6 months may be granted for members with any of the listed indications
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all initial authorization criteria
Approval duration
6 months