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.
