Aetna considers oprelvekin (Neumega) medically necessary for prevention of thrombocytopenia in persons who are receiving myelosuppressive therapy for non-myeloid malignancies who are at high-risk of severe thrombocytopenia (i.e., platelet count less than 50,000 or previous thromobytopenia with prior chemotherapy).
Aetna considers oprelvekin experimental and investigational for all other indications.Background
Neumega (oprelvekin) is indicated for the prevention of severe thrombocytopenia and the reduction of the need for platelet transfusions following myelosuppressive chemotherapy in adult patients with nonmyeloid malignancies who are at high risk of severe thrombocytopenia.
The recommended dose of oprelvekin in adults without severe renal impairment is 50 µg/kg given once daily (Wyeth, 2011). The recommended dose of Neumega (oprelvekin) in adults with severe renal impairment (creatinine clearance < 30 mL/min) is 25 µg/kg.
According to the product labeling, dosing should be initiated six to 24 hours after the completion of chemotherapy (Wyeth, 2011). Platelet counts should be monitored periodically to assess the optimal duration of therapy. Dosing should be continued until the post-nadir platelet count is ≥ 50,000/µL. The product labeling notes that, in controlled clinical trials, doses were administered in courses of 10 to 21 days. The product labeling states that dosing beyond 21 days per treatment course is not recommended.
The product labeling states that treatment with oprelvekin should be discontinued at least two days before starting the next planned cycle of chemotherapy.
|CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|Other CPT codes related to the CPB:|
|96372||Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular|
|HCPCS codes covered if selection criteria are met :|
|J2355||Injection, oprelvekin, 5 mg|
|ICD-10 codes covered if selection criteria are met:|
|C00.0 - C91.92, C93.00 - D09.9||Malignant neoplasms [excluding non- myeloid malignancies]|