Product Details

Neupogen

Filgrastim
480 mcg/1.6 mL
Solution for Injection
Single-Dose 1.6-mL Vial (Preservative-Free)

DIN/PIN/NPN

09853464

Manufacturer

Amgen Canada Inc.

Formulary Listing Date

2013-07-30

Unit Price

281.8120

Amount MOH Pays

281.8120

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

20:12:16 Hemostatics

Therapeutic Note

NO

ATC Code

Interchangeable Products

NO

LU Clinical Criteria

LU Code	Auth. Period	Clinical Criteria
682	12 months from date of authorization	For the treatment of low white blood cell count in patients who meet the following criteria: Patients who become pregnant during the transition period of July 31, 2024, to January 31, 2025.
683	12 months from date of authorization	For the treatment of low white blood cell count in patients who meet the following criteria: Patients who require palliative care during the transition period of July 31, 2024, to January 31, 2025.

EAP Criteria

Therapeutic Class	Reimbursement Criteria
Oncology – Supportive Management	Filgrastim [Granulocyte colony stimulating factor (G-CSF)] Brand(s): Neupogen Dosage Form/Strength: 300 mcg/mL, 480 mcg /1.6 mL Effective August 30, 2017, Exceptional Access Program (EAP) requests for Neupogen (filgrastim) will no longer be accepted for any indication. Patients who have an existing EAP approval for Neupogen can continue to receive Neupogen for the duration of the EAP approval period. Neupogen and Grastofil are not interchangeable products. As of August 30, 2017, new prescriptions for filgrastim for ODB eligible patients will be dispensed Grastofil, unless it specifies Neupogen with the appropriate LU code. Refer to the Ministry’s e-formulary for a listing of Limited Use (LU) criteria for Neupogen. Effective December 22, 2016, the subsequent entry biologic (SEB) filgrastim as Grastofil® is funded under the Ontario Drug Benefit (ODB) Program as a general benefit (GB). Please refer to the e-formulary for funded strengths.

Product Monograph