Anthem Blue Cross (HMO, PPO, EPO)
Neulasta Onpro (pegfilgrastim)
Drugs for the Blood : Drugs for the Blood
  • Neutropenia:
    Duration: 1 year(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Risk Factor for Developing Febrile Neutropenia (FN): 1 of Active tissue infection(s);Age greater than 65 years;Bone marrow involvement;Liver dysfunction;Poor performance status;Poor renal function;Previous episodes of febrile neutropenia/ infection
    Documented Diagnosis: Yes
    Criteria includes risk factor for developing FN: Yes

  • Prior Authorization: Neutropenia:
    PA Applies
  • Quantity Limit: 2 injectors/kits per 28 day(s).
  • Available only through Specialty Pharmacy;
    For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click HERE;
  • PA Applies