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Nyvepria — Medica

any indication meeting the respective standard Colony Stimulating Factors – Pegfilgrastim Products Prior Authorization Policy

Preferred products

  • Fulphila
  • Ziextenzo

Initial criteria

  • Patient meets the respective standard Colony Stimulating Factors – Pegfilgrastim Products Prior Authorization Policy criteria; AND
  • Patient has tried at least one of the following: Fulphila or Ziextenzo [documentation required]; AND
  • Patient cannot continue to use the Preferred medication(s) due to a formulation difference in the inactive ingredient(s) which, according to the prescriber, would result in a significant allergy or serious adverse reaction