Medicare AdvantagePrior AuthMedium impact
MA08.130i, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology, Internal Medicine +1 more·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans updated medical necessity criteria and medical coding requirements for Filgrastim (Neupogen®), related biosimilars, and Tbo-filgrastim (Granix®). This affects billing and prior authorization requirements for these white blood cell stimulating medications commonly used in cancer treatment and immune deficiency conditions.
Action Required
By July 1, 2025: Billing team must review and update prior authorization processes for Filgrastim (Neupogen®) and Tbo-filgrastim (Granix®) prescriptions for Medicare Advantage patients. Update billing system with new medical necessity criteria requirements. Notify providers of updated documentation requirements to prevent claim denials.