Non-Group Coverage (Group 1) Coverage for Seniors (Group 66) Palliative Coverage (Group 20514, Please note your client may have Group 1 or Group 66 coverage) Child and Family Services (Group 20403) Alberta Child Health Benefit (Group 20400) Children and Youth Services (Group 19824) Income Support (Group 19823) Alberta Human Services (AISH) (Group 19823) Alberta Adult Health Benefit (AAHB) (Group 23609)
"In patients with non-myeloid malignancies, receiving myelosuppressive anti-neoplastic drugs with curative intent, to decrease the incidence of infection, as manifested by febrile neutropenia."
"Following induction and consolidation treatment for acute myeloid leukemia, for the reduction in the duration of neutropenia, fever, antibiotic use and hospitalization."
"In patients with a diagnosis of congenital, cyclic or idiopathic neutropenia, to increase neutrophil counts and to reduce the incidence and duration of infection."
Please note for the first criterion: Coverage cannot be considered for palliative patients.
All requests for filgrastim must be completed using the Filgrastim/Pegfilgrastim/Plerixafor Special Authorization Request Form (ABC 60013).
Review Status / Past Decisions
Indication
Reviewing Body
Submission Completion Date
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
Review Status
N/A
Expert Committee
2021/01/15
2021/01/15
Special Authorization Criteria Change
N/A
Expert Committee
2020/09/22
2020/12/01
Special Authorization Criteria Change
PREVENTION OR TREATMENT OF NEUTROPENIA IN VARIOUS INDICATIONS
CDR - List with clinical criteria and/or conditions
Indication
PREVENTION OR TREATMENT OF NEUTROPENIA IN VARIOUS INDICATIONS
Reviewing Body
Common Drug Review
Submission Completion Date
2015/09/25
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2017/04/01
CDR Recommendation
Review Status
Special Authorization
APOTEX INC. (APX)
Telephone:(416) 749-9300
Toll-Free:(800) 268-4623
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NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.