Medicare AdvantageCoverageMedium impact
MA08.130j, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans have updated their medical necessity criteria and medical coding requirements for Filgrastim (Neupogen®), related biosimilars, and Tbo-filgrastim (Granix®). This pharmacy policy change affects billing and coverage determination for these white blood cell growth factor medications.
Action Required
Before April 20, 2026: Billing team must review and update billing procedures for Filgrastim (Neupogen®), related biosimilars, and Tbo-filgrastim (Granix®) to comply with new medical necessity criteria and coding requirements for Medicare Advantage plans. Access the full policy at the provided URL to understand specific documentation and coding changes. Update prior authorization workflows if required.