Medical Policy: Colony Stimulating Factors
Defines medical necessity, preferred vs non-preferred filgrastim products (Neupogen, Granix, Nypozi, Releuko, Zarxio) for commercial, Medicaid and Medicare members, applicable indications, dosing unit limits, length of authorization, billing codes and ICD-10 diagnoses.
Add Nypozi (filgrastim-txid) as a non-preferred agent to criteria.
Add Zarxio to Hematopoietic Subsyndrome of Acute Radiation Syndrome.
Annual Review: Removed J3590, Added Q5125, added NDCs: 63459-0918-xx and 63459-0920-xx (3/21/2024).
Initial Criteria: Myelodysplastic Syndrome criteria added (9/14/2023).
Added Releuko to affected agents (5/12/2022).
Extended coverage duration from 4 to 6 months (effective 01/01/2021).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.