High impact
Pegfilgrastim (Neulasta®); Pegfilgrastim-unne ( Armlupeg® ); Pegfilgrastim-pccg (Ennumo™); Pegfilgrastim-jmdb (Fulphila®); Pegfilgrastim-pbbk (Fylnetra®); Pegfilgrastim-apgf (Nyvepria™); Pegfilgrastim-fpgk (Stimufend®); Pegfilgrastim-cbqv (Udenyca®); Pegfilgrastim-bmez (Ziextenzo™)
BCBS Tennessee·Effective Oct 31, 2026
This is a new comprehensive medical policy covering 9 pegfilgrastim biosimilar products used to prevent febrile neutropenia in cancer patients receiving chemotherapy and for hematopoietic acute radiation syndrome. The policy establishes coverage criteria based on chemotherapy risk stratification, requires documentation of diagnosis and regimen, and mandates step therapy requirements. CRITICAL: Do not implement until 10/31/2026.