Aetna considers oprelvekin (Neumega) medically necessary for prevention of thrombocytopenia in personswho 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-9 Codes
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-9 codes covered if selection criteria are met:
The above policy is based on the following references:
Wyeth Pharmaceuticals, Inc. Neumega (oprelvekin). Prescribing Information. LAB-0455-1.0. Philadelphia, PA: Wyeth; revised January 2011.
[No authors listed.] Recombinant interleukin-11 for chemotherapy-induced thrombocytopenia. Med Lett Drugs Ther. 1998;40(1032):77-78.
Isaacs C, Robert NJ, Bailey FA, et al. Randomized placebo-controlled study of recombinant human interleukin-11 to prevent chemotherapy-induced thrombocytopenia in patients with breast cancer receiving dose-intensive cyclophosphamide and doxorubicin. J Clin Oncol. 1997;15(11):3368-3377.
Wilde MI, Faulds D. Oprelvekin: A review of its pharmacology and therapeutic potential in chemotherapy-induced thrombocytopenia. BioDrugs. 1998;10(2):159-171.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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