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.
