Know the Plans for Which You Qualify
You may be eligible for medical benefits through an employer- sponsored policy, a policy you bought on your own, the policy of your spouse, the federal Medicare program, or your state Medicaid plan. Many people are eligible for more than one program; in this case, one of the policies will be designated the "primary payor," and the other will be designated the "secondary payor." The primary payor is billed first, and the secondary payor generally is billed the remaining amount. Secondary payors may pay all or a part of your deductibles and/or coinsurance. If you have coverage from more than one insurer, contact both to determine who should be billed first for the product and who is secondary.
Understand Your Plan's PoliciesPrivate Insurers
The majority of health plans offered by private insurers (such as Blue Cross®/Blue Shield® plans, commercial insurers, and managed care organizations) will cover physician-administered prescription drugs, such as Neulasta® (pegfilgrastim) and NEUPOGEN® (Filgrastim), for medically appropriate uses. Many private-payor policies also cover prescription drugs obtained from pharmacies. However, you should check with your insurer about specific coverage to be certain. The reimbursement specialists at the Reimbursement Connection® can help you understand your insurance benefits, including your deductible, coinsurance, and out-of-pocket maximum amount for Neulasta® and NEUPOGEN®.
Managed care organizations (MCOs), health maintenance organizations (HMOs), or preferred provider organizations (PPOs) generally cover FDA-approved drugs when used according to their medically appropriate use, although some MCOs, HMOs, and/or PPOs require medications to be on a formulary (a list of approved drugs). MCOs, HMOs, and PPOs may also require patients to obtain treatment at preferred or network providers.
Medicare
Medicare is a federal program that provides health insurance for individuals 65 years of age and older and certain medically disabled individuals. Medicare usually covers injectable drugs, such as Neulasta® and NEUPOGEN®, if they are administered by, or under the supervision of, a physician.
Medicare beneficiaries may be able to purchase supplemental insurance policies (known as Medigap policies) to help pay for deductibles and coinsurance for Medicare-approved services. If you are a Medicare-eligible patient with supplemental insurance, this Medigap plan may cover part of the cost of Neulasta® and NEUPOGEN®.
Medicaid
Medicaid is a health insurance program jointly funded and administered by the federal and state governments. The program provides medical care for specified individuals with low income and resources. Benefits vary from state to state, but most cover physician-administered drugs such as Neulasta® and NEUPOGEN®. State Medicaid programs also generally cover prescription drugs dispensed through a pharmacy, although there may be limits to this coverage. If you think you may be eligible for the Medicaid program, ask the staff at your doctor's office for assistance in contacting your state Medicaid office.Other Sources of Medical Benefits
If you do not have health insurance through a private insurer, Medicare, and/or Medicaid, you may be covered under one of these other programs:
Continue to Filing Insurance Claims.
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The information provided in this section is of a general nature and for informational purposes only. Coding and coverage policies change periodically and often without warning. The responsibility to determine coverage and reimbursement parameters and appropriate coding for a particular patient and/or procedure is always the responsibility of the provider or physician. The information provided in this section should in no way be considered a guarantee of coverage or reimbursement for any product or service.
Neulasta® Indication and Important Product Safety Information
Neulasta® is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia.
Important Product Safety Information
Splenic rupture (including fatal cases), acute respiratory distress syndrome, and sickle cell crises have been reported. Allergic reactions, including anaphylaxis, have also been reported. The majority of these reactions occurred upon initial exposure. However, in rare cases, allergic reactions, including anaphylaxis, recurred within days after discontinuing anti-allergic treatment.
In a placebo-controlled trial, bone pain occurred at a higher incidence in Neulasta®-treated patients as compared to placebo-treated patients (31% vs 26%). The most common adverse events reported in either placebo- or active-controlled trials were consistent with the underlying cancer diagnosis and its treatment with chemotherapy, with the exception of bone pain.
© 2007 Amgen All Rights Reserved. Prescribing Information for Neulasta®
