CurrentCignaPolicy IP0597

Hematology - Aphexda

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This policy governs prior authorization and medical-necessity coverage for Aphexda (motixafortide) used with filgrastim to mobilize hematopoietic stem cells for collection and subsequent autologous transplantation in adults with multiple myeloma. It applies to providers submitting pharmacy benefit requests under applicable Cigna-administered plans.

Policy Summary

PayerCigna

PolicyHematology - Aphexda

Policy CodePolicy IP0597

Change TypeNo material change

Effective DateNov 15, 20261d

Last ReviewOct 29, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document that the patient meets the policy criteria and dosing requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

RequiredPrior authorization

1 monthApproval duration

2 dosesMaximum doses

1.25 mg/kgDose

Multiple myeloma

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