Limited coverage drugs – filgrastim

Last updated on August 26, 2024

Limited coverage criteria – filgrastim

Generic name

filgrastim

Brand name

Strength

Form

Grastofil®

300 mcg/0.5 mL 
480 mcg/0.8 mL

pre-filled syringe

Nivestym®

300 mcg/0.5 mL 
480 mcg/0.8 mL

pre-filled syringe

300 mcg/1 mL
480 mcg/1.6 mL

single-use vial

Nypozi®

300 mcg/0.5 mL
480 mcg/0.8 mL

pre-filled syringe

 

Special Authority criteria

Approval period

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

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

6 months

For the rescue of prolonged febrile neutropenia following chemotherapy

6 months

For cancer patients undergoing peripheral blood progenitor cell collection and therapy

6 months

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

6 months

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

6 months

For patients with the following benign disorders:

  • chronic benign cyclical neutropenia
    OR
  • 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 Centre for Excellence in HIV/AIDS

Special Authority requests