Medical benefit pharmaceutical policies for providers

See the latest updates to our medical benefit pharmaceutical policies. 

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W

MBP 59.0 White Blood Cell Stimulating Factors
White blood cell stimulating factors such as granulocyte colony stimulating factors (G-CSF) [e.g., Neupogen (filgrastim), Neulasta (pegfilgrastim) and Zarxio (pegfilgrastim-sndz)] and Granix (tbo-filgrastim) and granulocyte-macrophage colony stimulating factor (GM-CSF) [e.g., Leukine (sargramostim)] are synthetic stimulants and anti-neutropenic agents administered to decrease the incidence and/or severity of infection associated with drug-related myelosuppression and to assist recovery of hematopoietic function in neutropenia.
Reviewed 9/28/16

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