Price 2019 - L33747, Document id search results - centers for medicare and, Document id search results listed below are the search results that match your search criteria. select the document title to view the details page for the specific record.. Colony stimulating factors: neulasta® (pegfilgrastim), *neulasta is the only g-csf product used in the published clinical trials for these regimens. the requesting provider should provide journal citations supporting this request for regimens. D (s) neulasta (pegfilgrastim), Pharmacy pre-authorization criteria drug (s) neulasta (pegfilgrastim) • patient is undergoing myelosuppressive chemotherapy with an expected incidence of febrile neutropenia of 10-20% § and one or more of the following co-morbidities:.