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Zarxio® is the Preferred Filgrastim Therapy for Medicare Advantage Effective November 1, 2022

Audience: Prescribing Providers

We want to make you aware of an upcoming change regarding treatment with colony stimulating factors for Medicare Advantage members that will apply under the medical benefit.  The biosimilar Zarxio (filgrastim-sndz) is now our preferred filgrastim therapy for the treatment of febrile neutropenia, myeloid reconstitution, and neutropenia. As the preferred filgrastim therapy, Zarxio does not require prior authorization.

Additionally, beginning November 1, 2022, Neupogen®, Granix®, Nivestym®, and Releuko® will require prior authorization when billed under the medical benefit (administered by a health care provider). When submitting a prior authorization request for Neupogen, Granix, Nivestym, or Releuko please include all of the following relevant and required clinical information:

  • Diagnosis
  • Clinical justification as to why Zarxio is not the best choice for your patient
  • Rationale for why you are requesting a step therapy protocol override

This change applies to Medicare AdvantageIt impacts new starts only and does not apply to Medicare Advantage members currently prescribed Neupogen, Granix, Nivestym, or Releuko.  

Zarxio is a Biosimilar to Neupogen

A biosimilar product is a biologic product that is approved based on demonstrating that it is highly similar to an FDA-approved biologic product, known as a reference product, and has no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowed in biosimilar products.

Zarxio has the same mechanism of action, route of administration, dosage form and strengths as its reference product Neupogen. Treatment guidelines for myeloid growth factors do not currently prefer one particular filgrastim product over another.

To learn more about biosimilars and to review and print materials for your practice and your patients, please visit the FDA website.

To ensure accurate prescribing and correct claim submissions, please follow the requirements below and share this important information with your billing office/billing service and anyone in your practice who should be aware. If you have questions or concerns, please contact your Provider Relations representative.

Prescribing Requirements

Drug Name

All Lines of Business
Medical Benefit 
(Health Care Provider Administered)

Zarxio
 Preferred Product

No Prior Authorization Required

Neupogen
Non-Preferred Product

Prior Authorization Required

Granix
Non-Preferred Product

Prior Authorization Required

Nivestym

Non-Preferred Product

 Prior Authorization Required

Releuko

Non-Preferred Product

 Prior Authorization Required

Billing Requirements

Q-code

NDC

Q5101 Injection, filgrastim-sndz, biosimilar, (Zarxio), 1 microgram

Zarxio 300 mcg / 0.5ml Solution Prefilled Syringe:

  • 61314-0318-01
  • 61314-0318-05
  • 61314-0318-10

Zarxio 480 mcg / 0.8ml Solution Prefilled Syringe:

  • 61314-0326-01
  • 61314-0326-05
  • 61314-0326-10

     

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