OH Epic Formulary restricted to:

• Indication: to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan containing regimen for extensive-stage small cell lung cancer (ES-SCLC). 
• Service Line: hematology/oncology
• Formulary Location: outpatient infusion
• Service location: outpatient infusion
• Patient Population: adult
• Prior Authorization Required: yes
• Restriction/Criteria of Use (all will apply unless specified):
  • Confirmed diagnosis of extensive-stage small cell lung cancer (ES-SCLC)
  • Receiving a platinum/etoposide-containing regimen or topotecan containing regimen
  • Must meet at least one of the following criteria:
    • Recurrent disease with prior chemotherapy-related hematologic issues
    • Baseline low counts
    • Baseline severe hepatic or renal dysfunction
    • Concomitant hematologic disorder
    • Metastases to bones
    • Prior radiation to hips/femur

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