CommercialDocumentationMedium impact
08.01.73i, Filgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology, Critical Care +1 more·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.01.73i updates medical necessity criteria and medical coding requirements for Filgrastim (Neupogen®), related biosimilars, and tbo-filgrastim (Granix®). This recent policy change effective July 1, 2025, impacts how these colony-stimulating factor medications are billed and authorized for commercial plans.
Action Required
By July 1, 2025: Billing team must review and implement updated medical necessity criteria for Filgrastim, biosimilars, and Granix® in the billing system. Providers should update documentation templates to capture required medical necessity elements per policy 08.01.73i. Contact the insurance carrier (IBX) for specific coding guidance and any prior authorization requirements. Verify all claims include appropriate medical necessity documentation to prevent denials. Reference the full policy at the provided URL for detailed criteria and coding updates.