CommercialCoverageHigh impact
08.01.73j, Filgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)
Independence Blue Cross·PA · Oncology, Hematology, Pediatrics +2 more·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.01.73j to 08.01.73k, effective 04/20/2026, adding filgrastim-laha (Filkri) to the nonpreferred product list and expanding coverage criteria for filgrastim use in CAR-T therapies, specific pediatric malignancies, and additional chemotherapy regimens per updated NCCN guidelines. Billing teams must update systems to recognize the new HCPCS code Q5172 for filgrastim-laha and enforce preferred product requirements (Zarxio, Nivestym) with nonpreferred product coverage only when contraindications, intolerances, or inadequate response to preferred products are documented.
Action Required
By April 20, 2026: (1) Billing team must update billing system to recognize HCPCS code Q5172 (filgrastim-laha/Filkri) and reclassify it as a nonpreferred product requiring prior authorization or evidence of contraindication/intolerance to preferred products (Q5101 Zarxio, Q5110 Nivestym). (2) Update claim adjudication rules to deny claims for nonpreferred filgrastim products (J1442, Q5125 Releuko, Q5148 Nypozi, J1447 tbo-filgrastim, filgrastim-laha/Filkri) unless prior authorization documentation shows contraindication, documented intolerance, or inadequate response to Zarxio or Nivestym. (3) Providers and coding staff must update documentation templates and prior authorization request forms to capture the expanded indications: CAR-T therapies, IEC therapies, pediatric Hodgkin lymphoma (Bv-AVD/nivolumab-AVD), pediatric post-transplant lymphoproliferative disorders (CHOP regimen), Burkitt lymphoma, diffuse large B-cell lymphoma, primary mediastinal large B-cell lymphoma, and new chemotherapy regimens (Melphalan PHP for melanoma; DCEP and high-dose cyclophosphamide for breast cancer; FLOT for esophageal/gastric cancers; docetaxel and FOLFIRINOX for prostate cancer). (4) Remove legacy language from 'Not Medically Necessary' section regarding first-course filgrastim restrictions from all internal documentation and claim review criteria. Failure to implement prior authorization enforcement will result in claim denials and payment recoupment.