Medical Policy Revision: Granulocyte Colony Stimulating Factor and Granulocyte-Macrophage Colony Stimulating Factor
Effective October 1, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the use of Neupogen (filgrastim).
Claims for services provided on and after October 1, 2016 to members enrolled in a Horizon BCBSNJ plan will be processed according to the guidelines of our revised medical policy, Granulocyte Colony Stimulating Factor (G-CSF - Neupogen, Neulasta) and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF - Leukine).
Based on updated literature (sources are documented within the policy), our policy includes revised criteria for the use of Neupogen (filgrastim).
Review this revised policy in our Medical Policy Manual.
Based on the guidelines of this revised medical policy, effective October 1, 2016, Horizon BCBSNJ, and business partners working on our behalf, may require that a patient try Granix (tbo-filgrastim) or Zarxio (filgrastim‐sndz) and have an inadequate response or adverse event prior to approving the use of Neupogen (filgrastim).
Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after October 1, 2016.
This document contains references to brand name prescription medicines that are trademarks or registered marks of pharmaceutical manufacturers that are not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.