Limited Coverage Drugs – Filgrastim

Generic Name

filgrastim

Strength

filgrastim 300 mcg, 480 mcg

Form

pre-filled syringe

Grastofil® (as of January 31, 2017)

Special Authority Criteria

Approval Period

1. For secondary prophylaxis of febrile neutropenia in cancer patients receiving potentially curative myelosuppressive chemotherapy.

6 months

2. For the rescue of prolonged febrile neutropenia following chemotherapy.

6 months

3. For cancer patients undergoing peripheral blood progenitor cell (PBPC) collection and therapy.

6 months

4. For post-Bone Marrow Transplant patients to stimulate bone marrow engraftment (start greater than or equal to d+1).

6 months

5. For post-Bone Marrow Transplant patients requiring rescue of failure to engraft (start greater than or equal to d+14).

6 months

6. For patients with the following benign disorders:

a) Chronic benign cyclical neutropenia; OR

b) A myelodysplastic disorders or aplastic anemia who are awaiting bone marrow transplantation.

6 months

Practitioner Exemptions

  • None

Special Notes

  • As of January 31, 2017, PharmaCare covers only the Grastofil brand for patients seeking Special Authority for filgrastim for the indications above.
  • PharmaCare covers Grastofil® and Neupogen® for patients who were granted a Special Authority for Neupogen before January 31, 2017 until that Special Authority coverage expires.
  • For coverage for HIV infected patients, please contact BC Center for Excellence in HIV/AIDS.

Special Authority Request Form(s)