Non-myeloid Malignancies

Covered Uses (Including All FDA-approved Age Coverage Prior ...
Indications not otherwise excluded from Part D) Exclusion Criteria Required Medical Information Age Restrictions Coverage Duration Other Criteria ACNE • CRF and patients with non-myeloid malignancies – hemoglobin level of the patient (not the result of a recent blood transfusion) greater ... Access Full Source

UPMC Health Plan POLICY AND PROCEDURE MANUAL
Pegfilgrastim (Neulasta) is indicated to decrease the incidence of infection manifested as febrile neutropenia in members with non-myeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia. ... Doc Retrieval

Template:Myeloid malignancy - Wikipedia, The Free Encyclopedia
How to manage this template's initial visibility To manage this template's visibility when it first appears, add the parameter: |state=collapsed to show the template in its collapsed state, i.e. hidden apart from its titlebar – e.g. {{Myeloid malignancy |state=collapsed}} ... Read Article

Diagnosis Code-Restricted Physician-Administered Drugs
042, 07953 Anemia from Acquired Immune Deficiency Syndrome (AIDS) 140-20491, 230-2386, 2388-2399, 2733 Non-myeloid malignancies or multiple myeloma ... Fetch This Document

BRAND NAME: Neulasta (Generic) (pegfilgrastim)
Benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of ... Retrieve Full Source

ARANESP . Covered Uses: All FDA-approved indications not otherwise excluded from Part D. Myelodysplastic syndrome. Exclusion Criteria: Required Medical Information: • Chemotherapy‐induced anemia in patients with non‐myeloid malignancies: ... Doc Viewer

GRANIX (tbo FILGRASTIM), NEUPOGEN (FILGRASTIM)/NEULASTA ...
PRIOR AUTHORIZATION CRITERIA Original Development Date Jul y 18, 2013 Revision Date April 17 non -myeloid malignancies undergoing myeloablative chemotherapy followed by autologous or allogeneic bone marrow transplantation (BMT). ... Return Doc

Cigna Medical Coverage Policy
Another 2 months for the treatment of non-myeloid malignancies • in lymphoproliferative disorders (myeloma, non-Hodgkin’s lymphoma and chronic lymphocytic leukemia) if Hgb does not increase following chemotherapy ... Get Content Here

Induced anemia in patients with non-myeloid malignancies: Hemoglobin (Hgb) value prior to initiation of therapy is less than 10 g/dL. For myelodysplastic syndrome (MDS): Hgb value prior to initiation of therapy ... Retrieve Doc

NEUPOGEN, LEUKINE, NEULASTA* PRIOR AUTHORIZATION FORM
NEUPOGEN, LEUKINE, NEULASTA* PRIOR AUTHORIZATION FORM Coverage Criteria: Covered to decrease the incidence of infection, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a significant incidence of severe neutropenia with fever. ... Get Doc

Corporate Medical Policy Erythropoiesis-Stimulating Agents (ESAs)
Erythropoiesis-stimulating agents (ESAs) are produced using recombinant DNA technologies. treatment of anemia in cancer patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy; ... Read Content

Topic - Regence.com
With non-myeloid malignancies who receive concomitant chemotherapy. [22-36, 46] Administration of erythropoietin has been shown to increase hemoglobin levels and reduce the numbers of transfusions in patients with non-myeloid malignancies who ... Fetch Doc

Tumors Of The Hematopoietic And Lymphoid Tissues - Wikipedia ...
Tumors of the hematopoietic and lymphoid tissues or haematopoietic and lymphoid malignancies are tumours that affect the blood, bone marrow, lymph, and lymphatic system. ... Read Article

Diagnosis Code-Restricted Physician-Administered Drugs
Diagnosis Code-Restricted Physician-Administered Drugs J0585 Botulinum Toxin Type A (Botox) Darbepoetin alfa in albumin Non-myeloid malignancies or multiple myeloma 20610 Chronic myelomonocytic leukemia 2387, 2849, 2850 Myelodysplastic syndrome ... Get Content Here

PEGFILGRASTIM (Neulasta) - North Dakota
PEGFILGRASTIM (Neulasta) CPT CODE: J2505 Injection, pegfilgrastim, 6 mg (Neulasta), cycle Indication for use: To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a ... Fetch This Document

Therapeutic Class Overview Erythropoiesis-Stimulating Agents
Patients with non-myeloid malignancies where anemia is due to the effect of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy Single-dose vial (polysorbate solution or albumin solution): ... Fetch Content

PHARMACY PRIOR AUTHORIZATION Clinical Guideline ...
Erythropoiesis-Stimulating Agents . Epogen malignancies where anemia is due to the effect of concomitantly administered chemotherapy. Dosage Forms Diagnosis of non-myeloid malignancy (e.g., solid tumor) ... Read Document

CinnaGen - Wikipedia, The Free Encyclopedia
Treatment of Anemia in Patients with Non-Myeloid Malignancies. CinnoPar (Teriparatide) (for Treatment of osteoporosis in postmenopausal women who are at high risk for fracture. ... Read Article

Cephalon, Inc. GRANIX- Filgrastim Injection, Solution
With non-myeloid malignancies receiving GRANIX. No complications attributable to leukocytosis were reported in clinical studies. Additional Adverse Reactions Other adverse reactions known to occur following administration of human granulocyte colony- ... Get Content Here

Granulocyte Colony Stimulating Factor Interchange And ...
Myelosuppressive chemotherapy used to treat non-myeloid malignancies. Restriction. Interchange: of filgrastim (Neupogen ®) to use in hematopoietic (bone marrow) stem cell transplantation and myeloid malignancies (acute myeloid leukemia [A ML], chronic myeloid ... Doc Viewer

Beneficiary’s Medicaid ID#
Recipient’s Medicaid ID # Date of Birth (MM/DD/YYYY) / / Recipient’s Full Name . Prescriber’s Full Name . Prescriber Cancer patients with non-myeloid malignancies receiving myelosuppressive chemotherapy (Approve for 12 months) ... Read Document