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

Therapeutic Note

NO

ATC Code

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
447 14 days

Pre-Stem Cell Transplant Mobilization:

For Peripheral Blood Progenitor Cell (PBPC) collection for peripheral stem cell transplant as treatment for malignant disease.

Approval for Neupogen 300mcg and 480mcg vial format only.

Note: Reimbursement is limited to the duration required per the treatment protocol and to prescriptions written by an oncologist or hematologist.
500 1 year

For pediatric patients (less than 18 years age) who are unable to achieve the appropriate dose of granulocyte colony-stimulating factor with the formulary listed formats of pre-filled syringes.

Approval for Neupogen 300mcg vial format only.
501 Indefinite

For patients who are unable to use available formats of Grastofil due to a documented latex allergy.

Approval for Neupogen 300mcg and 480mcg vial format only.
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

View Monograph