FillMapKP OR Family Dental - $100 Ded

Does KP OR Family Dental - $100 Ded cover filgrastim?

KP OR Family Dental - $100 Ded
71287-71287OR0590003-0 · ACA · ACA Marketplace
filgrastim
filgrastimunder KP OR Family Dental - $100 Ded
Covered — some forms require prior authorization
12 of 14 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay

This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
Tier
Specialty
Approval first
Required
Try another first
No
Amount limit
Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Covered forms and strengths (14)

  • 0.5 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen]Approval firstAmount limit
  • 0.5 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym]Approval firstAmount limit
  • 0.5 ML filgrastim-laha 0.6 MG/ML Prefilled Syringe [Filkri]
  • 0.5 ML filgrastim-sndz 0.6 MG/ML Prefilled Syringe [Zarxio]Approval firstAmount limit
  • 0.5 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix]Approval first
  • 0.8 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen]Approval firstAmount limit
  • 0.8 ML filgrastim-aafi 0.6 MG/ML Prefilled Syringe [Nivestym]Approval firstAmount limit
  • 0.8 ML filgrastim-laha 0.6 MG/ML Prefilled Syringe [Filkri]
  • 0.8 ML filgrastim-sndz 0.6 MG/ML Prefilled Syringe [Zarxio]Approval firstAmount limit
  • 0.8 ML tbo-filgrastim 0.6 MG/ML Prefilled Syringe [Granix]Approval first
  • 1 ML filgrastim 0.3 MG/ML Injection [Neupogen]Approval firstAmount limit
  • 1 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym]Approval firstAmount limit
  • 1.6 ML filgrastim 0.3 MG/ML Injection [Neupogen]Approval firstAmount limit
  • 1.6 ML filgrastim-aafi 0.3 MG/ML Injection [Nivestym]Approval firstAmount limit

← All coverage for filgrastim