Medicare AdvantageCoverageMedium impact
MA08.130i, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA policy MA08.130i to MA08.130k effective 07/01/2025, aligning filgrastim coverage criteria with current FDA, NCCN, and ASCO guidelines. Key changes include revised AML consolidation chemotherapy prophylaxis criteria, updated chemotherapy regimen examples in Attachment A, and deletion of HCPCS code C9173 (filgrastim-txid/Nypozi). ICD-10 diagnosis codes are no longer listed in the policy; billing teams must report appropriate codes based on medical necessity.
Action Required
By July 1, 2025: (1) Billing team must remove HCPCS code C9173 (filgrastim-txid/Nypozi) from all billing systems, fee schedules, and encounter templates—claims submitted with this code will be denied. (2) Update prior authorization protocols to reflect revised AML consolidation chemotherapy prophylaxis criteria per updated NCCN guidelines. (3) Update chemotherapy regimen reference lists in Attachment A: add BrECADD for Hodgkin's lymphoma, add sacituzumab govitecan-hziy (Enhertu) for Breast Cancer, and move Carboplatin/docetaxel from intermediate-risk to high-risk (>20%) category for Ovarian Cancer. (4) Remove any hardcoded ICD-10 diagnosis codes from billing templates and train coding staff to select the most appropriate diagnosis code based on clinical documentation supporting medical necessity. (5) Verify that preferred product rules remain in place: filgrastim-sndz (Zarxio) and filgrastim-aafi (Nivestym) as preferred; nonpreferred products (Neupogen, Nypozi, Granix, Releuko, Filkri) require documentation of contraindication, intolerance, or inadequate response to preferred agents. Failure to implement code deletion and update prior auth criteria will result in claim denials and potential compliance issues.