Drug Type: Non Formulary

Tbo-Filgrastim Subcutaneous Soln 480 MCG/1.6ML (Granix) Sol

Advisories: Oncologist/ Hematologist Use Only Non-Formulary Use Criteria:1. Adjunctive therapy for cancer chemotherapy. a. Chemotherapy primary prophylaxis for “dose dense” treatment regimen. b Chemotherapy primary prophylaxis for treatment regimen with 20% or higher risk of febrile neutropenia. c. Chemotherapy primary prophylaxis for patient older than 65, poor performance status, combined chemoradiotherapy, poor nutritional status, advanced cancer, or other serious comorbidities. d. Chemotherapy secondary prophylaxis for patient with history of prior neutropenic complications. 2. All of the following must be true for patient to be eligible for tbo-filgrastim treatment of hepatitis C treatment-related neutropenia: a. Patient receiving hepatitis C therapy ; AND b. Patient develops neutropenia defined as either i. ANC < 250/mm3; or ii. ANC < 500mm3 with one of the following risk factors for developing infection; a. Cirrhosis, biopsy proven or clinically evident; b. Pre-or post-liver transplant; c. HIV/HCV co-infection d. Receiving HCV triple therapy; AND c. Patient has failed to respond (i.e. neutropenia persists) despite at least two weeks of peginterferon dose reduction. Medical Referral Center (MRC) Use Only MLP Requires Cosign

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