Non-Preferred Filgrastim Products: Neupogen, Nypozi, Releuko, Filkri (Revised)

Before January 1, 2026 (or immediately if already in effect): Billing and prior authorization teams must implement the following: (1) Update billing system and prior auth protocols to require documentation of previous treatment with or intolerance to preferred filgrastim products (Zarxio for Medical Benefit requests; Zarxio AND Nivestym for Part D requests) before approving claims for non-preferred products (Neupogen, Nypozi, Releuko, Filkri). (2) For Medicare Part B requests, add exception rule: do NOT require step therapy if the request is a continuation of prior therapy within the past 365 days. (3) Ensure prior authorization staff verify that members have ONE of the required diagnoses (febrile neutropenia treatment/prophylaxis, AML, stem cell harvesting, MDS neutropenia, etc.) and meet all applicable clinical criteria for their indication. (4) Update prior auth templates and checklist forms to capture documentation of prior preferred product exposure or intolerance. (5) Train providers submitting claims to include documentation of failed or intolerant previous therapies when requesting non-preferred filgrastim products. Failure to obtain proper prior authorization will result in claim denials or member cost-sharing issues.