Skip to content
The Policy VaultThe Policy Vault

Neupogen — Medica

any indication meeting the respective standard Colony Stimulating Factors Prior Authorization Policy criteria

Preferred products

  • Nivestym
  • Zarxio

Initial criteria

  • Patient meets the respective standard Colony Stimulating Factors Prior Authorization Policy criteria AND
  • Patient has tried at least one Preferred Product (Nivestym or Zarxio) OR qualifies for approval under the Non-Preferred Product exception criteria

Reauthorization criteria

  • Reauthorization follows durations and requirements noted in the respective standard Colony Stimulating Factors Prior Authorization Policy

Approval duration

per standard Colony Stimulating Factors Prior Authorization Policy