Medical Policy Updates

Notification of Policy Revisions Effective July 1, 2020 (Posted April 28, 2020)

Medical Policy Revision
White Blood Cell Growth Factors "Notification" Updated "When Covered" section with the following requirements for Neulasta/Neulasta OnPro and Neupogen requests: "the patient has a documented life-threatening side effect that required medical intervention to a biosimilar pegfilgrastim or filgrastim product that is not anticipated with its originator product, Neulasta/Neulasta OnPro or Neupogen; AND the prescriber has completed and submitted an FDA MedWatch Adverse Event Reporting Form (the prescriber must provide a copy of the completed MedWatch form. Authorizations will not be considered unless the form is completed and submitted to the FDA)." Specialty Matched Consultant Advisory Panel review 4/15/2020. Medical Director review 4/2020. Notification given 4/28/2020 for effective date 7/1/2020.