CommercialCoverageMedium impact
Update to Filgrastim Product Coverage
Medical Mutual of Ohio·Oncology, Hematology, Internal Medicine·In the News
Effective date
Nov 1, 2018
We identified it
Jun 20, 2026
Summary
Medical Mutual is changing filgrastim product coverage effective November 1, 2018, making Zarxio the preferred product while requiring prior trial of Zarxio before covering non-preferred products (Neupogen and Nivestym). This affects Commercial, ACA, and Medicare Advantage plans.
Action Required
Immediately: Billing team must update prior authorization workflows to require trial of Zarxio before prescribing Neupogen or Nivestym for Medical Mutual members. Providers should be notified to prescribe Zarxio as first-line filgrastim therapy. Update clinical protocols and EMR alerts for Medical Mutual Commercial, ACA, and Medicare Advantage plans to prevent claim denials.