Limited Coverage Drugs – Filgrastim

Generic Name

filgrastim

Strength

300 mcg/0.5 mL, 480 mcg/0.8mL

Form

pre-filled syringe

Special Authority Criteria

Approval Period

1. For primary prophylaxis of febrile neutropenia in cancer patients receiving potentially curative myelosuppressive chemotherapy regimens where the risk of febrile neutropenia is ≥ 20%. 6 months

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

6 months

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

6 months

4. For cancer patients undergoing peripheral blood progenitor cell collection and therapy.

6 months

5. For post-bone marrow transplant patients to stimulate bone marrow engraftment (start greater than or equal to d+1).

6 months

6. For post-bone marrow transplant patients requiring rescue of failure to engraft (start greater than or equal to d+14).

6 months

7. For patients with the following benign disorders:

a) Chronic benign cyclical neutropenia; OR

b) Myelodysplastic disorders or aplastic anemia, while the patient awaits bone marrow transplantation.

6 months

Practitioner Exemptions

  • None

Special Notes

  • For coverage for HIV infected patients, please contact BC Center for Excellence in HIV/AIDS.

Special Authority Request Form(s)