UNC Health

     System Formulary Restriction:

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

     Use of Udenyca 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 Udenyca or do not cover Fulphila injection

     Use of Neulasta Onpro injection and Udeynca OnBody 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 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

• Lexicomp
• Micromedex
• UpToDate
• FDA Daily Med