UNC Health Medication Formulary
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UNC Health Medication Formulary
Change Request Form Chemical/SDS Search UNC Health.org
Search results for:

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-cbqv (Udenyca OnBody) SOLUTION, SUBCUTANEOUS 0.6 mg/6 mL              
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:

Inpatient: no inpatient use allowed

Outpatient:

    • Fulphila: recommended first line product
    • Udenyca: Restricted to those who meet the following criteria:
      • Initiation of therapy in patients with insurance restrictions that require Udenyca or do not cover Fulphila injection
    • Neulasta Onpro injection and Udeynca OnBody injection: restricted to those who meet at least one of the following criteria:
      • Continuation of therapy in patients who previously received Neulasta Onpro or Udenyca OnBody
      • Initiation of therapy in patients with insurance restrictions that do not cover Udenyca or Fulphila injection, or require Neulasta OnPro or Udenyca OnBody
      • 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

Payer Policy Coverage: Filgrastim and Pegfilgrastim Coverage

Med Center
     UNC Medical Center Formulary Restrictions

Rex
     Rex Hematology-Oncology Formulary Restrictions

Wayne
     Wayne Therapeutic Interchange

Last updated: Dec. 29, 2025






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