Comprehensive medication guide to Nivestym including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$50 copay with commercial insurance through the Pfizer Oncology Together Copay Program; Medicare Part B patients pay 20% coinsurance after deductible. Prior authorization required for most plans.
Estimated Cash Pricing
$222–$445+ per dose depending on formulation; 300 mcg/0.5 mL syringes start around $222, 480 mcg/0.8 mL around $307–$445 with discount cards. Multi-dose vials can exceed $3,000 for a full supply.
Medfinder Findability Score
68/100
Summarize with AI
On this page
Nivestym (filgrastim-aafi) is an FDA-approved biosimilar to Neupogen (filgrastim), manufactured by Pfizer and approved on July 20, 2018. It belongs to the granulocyte colony-stimulating factor (G-CSF) class of medications — biologics that stimulate the bone marrow to produce more neutrophils, the white blood cells that fight bacterial and fungal infections.
Nivestym is most commonly prescribed for patients undergoing cancer chemotherapy to prevent febrile neutropenia — a potentially life-threatening drop in white blood cells. It is also used in bone marrow transplantation, stem cell mobilization, and severe chronic neutropenia (congenital, cyclic, or idiopathic). It is available as prefilled syringes (300 mcg/0.5 mL and 480 mcg/0.8 mL) and single-dose vials, administered by subcutaneous injection or IV infusion.
As a biosimilar, Nivestym has been FDA-approved as highly similar to Neupogen with no clinically meaningful differences in safety, purity, or effectiveness. It is not a controlled substance and can be prescribed by any licensed provider with prescribing authority, though in practice it is almost exclusively managed by oncologists, hematologists, and transplant specialists.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Nivestym is a recombinant form of human granulocyte colony-stimulating factor (G-CSF) — a protein naturally produced by your body to regulate white blood cell production. Nivestym works by binding to G-CSF receptors on bone marrow stem cells, activating a signaling cascade that stimulates these cells to proliferate, differentiate, and mature into functional neutrophils.
Chemotherapy destroys rapidly dividing cells — including bone marrow stem cells — causing neutrophil counts to plummet. Nivestym counters this by providing a strong G-CSF signal that dramatically accelerates neutrophil production, typically raising the absolute neutrophil count (ANC) within 1-2 days of the first injection. The bone marrow's increased activity during Nivestym therapy is what causes the bone pain that many patients experience — the marrow is physically expanding to produce more cells.
At higher doses (10 mcg/kg/day), Nivestym also mobilizes hematopoietic stem cells from the bone marrow into the bloodstream — making them available for collection via leukapheresis for autologous stem cell transplants. This dual function makes G-CSF biologics like Nivestym essential tools in modern oncology and hematology.
300 mcg/0.5 mL — prefilled syringe
For subcutaneous injection; comes with BD UltraSafe Plus Passive Needle Guard
480 mcg/0.8 mL — prefilled syringe
For subcutaneous injection; most common dose for standard-weight adults
300 mcg/mL — single-dose vial
For subcutaneous or IV use; allows smaller dose measurement
480 mcg/1.6 mL — single-dose vial
For subcutaneous or IV use; multi-dose equivalent for cycle supply
Nivestym is not on the FDA's official drug shortage list as of 2026. However, as a specialty biologic requiring refrigeration, it is not routinely stocked at most retail pharmacies. Availability varies significantly from pharmacy to pharmacy and can be affected by chemotherapy cycle demand surges, insurance prior authorization requirements, and formulary competition from other filgrastim biosimilars (Zarxio, Releuko, Nypozi).
Patients are most likely to find Nivestym through specialty pharmacies (CVS Specialty, Walgreens Specialty, Accredo) and hospital-affiliated outpatient pharmacies. Standard retail locations typically need to order it, which can take 1-2 business days. For patients on time-sensitive chemotherapy schedules, this delay can be clinically significant.
If you're having trouble locating Nivestym, medfinder calls pharmacies near you to check which ones have it in stock — so you don't have to spend hours on hold. You provide your medication, dosage, and location, and medfinder texts you the results.
Nivestym is not a controlled substance and has no DEA scheduling, so any licensed prescriber can write a prescription. However, due to its specialized oncology and hematology indications, it is almost always prescribed by specialists with expertise in cancer care or blood disorders.
Nivestym is initiated in clinical settings where injection training can be provided. Once established and trained, patients can self-administer via subcutaneous injection at home. Telehealth follow-up appointments for ANC monitoring and dose adjustments are available at many oncology practices after the initial in-person visit.
No. Nivestym (filgrastim-aafi) is not a controlled substance and has no DEA scheduling. It does not have abuse potential and is not subject to the prescribing restrictions, refill limitations, or monitoring requirements that apply to Schedule II-V controlled substances.
Any licensed healthcare provider with prescribing authority — including oncologists, hematologists, nurse practitioners, and physician assistants — can prescribe Nivestym without DEA licensing requirements. However, because of its specialized indications and the need for injection training, it is almost always prescribed within a cancer care or hematology setting. Prior authorization from insurance is typically required, which serves as the primary administrative gate for obtaining Nivestym, not controlled substance scheduling.
Most patients experience at least one of the following common side effects during Nivestym therapy:
Seek immediate medical attention if you experience:
Know what you need? Skip the search.
Zarxio (filgrastim-sndz)
First FDA-approved filgrastim biosimilar (Sandoz, 2015). Most widely available; prefilled syringes can be stored at room temperature up to 4 days vs. 24 hours for Nivestym. Same indications as Nivestym.
Releuko (filgrastim-ayow)
Biosimilar approved February 2022. Similar indications to Nivestym but NOT approved for PBPC mobilization. Check with provider before switching.
Nypozi (filgrastim-txid)
Newest filgrastim biosimilar (June 2024). Broadest indication set including H-ARS. Growing market availability.
Neupogen (filgrastim)
Original reference biologic by Amgen (FDA-approved 1991). Broadest indications including H-ARS. Typically more expensive than biosimilars.
Neulasta (pegfilgrastim)
Long-acting pegylated G-CSF given once per chemotherapy cycle instead of daily. Not approved for BMT, AML, or severe chronic neutropenia indications.
Prefer Nivestym? We can find it.
Cytotoxic chemotherapy
majorDo not administer Nivestym within 24 hours before or after cytotoxic chemotherapy. Concurrent use may increase bone marrow toxicity.
Pegfilgrastim (Neulasta, Udenyca, and biosimilars)
majorDo not use Nivestym simultaneously with pegfilgrastim products. Both work through the same G-CSF pathway; concurrent use provides no benefit and may cause excessive leukocytosis.
Lithium
moderateLithium may potentiate the release of neutrophils from bone marrow. When combined with Nivestym, this can cause exaggerated leukocytosis. More frequent CBC monitoring is recommended.
Sargramostim (GM-CSF) and other colony-stimulating factors
moderateConcurrent use of G-CSF (Nivestym) with GM-CSF agents (sargramostim) is not recommended. May cause unpredictable WBC counts and is generally prohibited by payer PA policies.
Bone imaging agents
minorNivestym dramatically increases bone marrow activity and can interfere with bone scan results, potentially causing false positive findings. Inform radiologists and ordering providers of Nivestym use.
Nivestym (filgrastim-aafi) plays a critical role in modern cancer care, protecting patients from potentially life-threatening infections during chemotherapy. As a Pfizer-manufactured biosimilar to Neupogen, it brings the same proven G-CSF efficacy at a lower cost — making it an important option in a healthcare landscape where financial toxicity is a growing concern.
The primary challenge with Nivestym in 2026 is not availability at the national level — there is no active FDA shortage — but rather at the local level. As a specialty biologic, it requires cold-chain distribution and is not stocked at most retail pharmacies. Prior authorization adds further friction. Patients and providers who understand these dynamics — and know to route prescriptions to specialty pharmacies, engage savings programs, and consider biosimilar alternatives when needed — are best positioned to navigate the system successfully.
If you're having trouble finding Nivestym at a pharmacy near you, medfinder can help. Our service calls pharmacies near you to check stock and texts you the results — so you can spend your energy on your health, not on hold music.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini