UNC Health Medication Formulary
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UNC Health Medication Formulary
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pegfilgrastim

pegfilgrastim
Drug Name Form Strength ARHS Blue Ridge Caldwell Chatham Johnston Lenoir Medical Center Nash Pardee Rex Rockingham Southeastern Wayne Youth Behavioral Health
Pegfilgrastim (Neulasta Onpro Kit) SOLUTION, SUBCUTANEOUS 10 mg/mL (6 mg/0.6 mL)                
Pegfilgrastim-cbqv (Udenyca) SOLUTION, SUBCUTANEOUS 10 mg/mL (6 mg/0.6 mL)        
Pegfilgrastim-jmbd (Fulphila) SOLUTION, SUBCUTANEOUS 10 mg/mL (6 mg/0.6 mL)          

UNC Health

     System Formulary Restriction:

     Use of Udenyca injection is restricted to outpatient encounters or clinic use only (ie, no inpatient use)

     Use of Fulphiia injection is restricted to outpatient encounters or clinic use only (ie, no inpatient use) who meet the following criteria: 

  • Initiation of therapy in patients with insurance restrictions that require Fulphila or do not cover Udenyca injection

     Use of Neulasta Onpro injection is restricted to patients in outpatient or clinic encounters (ie, no inpatient use) who meet at least one of the following criteria: 

  • Continuation of therapy in patients who previously received Neulasta Onpro Kit
  • Initiation of therapy in patients with insurance restrictions that do not cover Udenyca or Fulphila injection, or require Neulasta OnPro Kit 
  • Transportation issues causing financial hardship
  • Facility bound where the facility will not transport 2 days in a row
  • Live greater than 45 miles from a treatment/infusion center

Med Center
     UNC Medical Center Formulary Restrictions

Rex
     Rex Hematology-Oncology Formulary Restrictions

Wayne
     Wayne Therapeutic Interchange


Last updated: Mar. 27, 2024







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