Doptelet — Blue Cross Blue Shield of Alabama

Initial criteria

• - Diagnosis of chronic (≥12 months) ITP AND:
• • Platelet count ≤30×10^9/L OR platelet count >30×10^9/L but <50×10^9/L with symptomatic bleeding or increased risk for bleeding
• • ONE of the following:
• - Tried and inadequate response to ONE corticosteroid OR intolerance/hypersensitivity OR FDA labeled contraindication to ALL corticosteroids
• - Tried and inadequate response to another thrombopoietin receptor agonist (e.g., Nplate, Promacta) or Tavalisse
• - Tried and inadequate response to immunoglobulin (IVIg or Anti-D)
• - Inadequate response to splenectomy
• - Tried and inadequate response to rituximab
• - OR thrombocytopenia with chronic liver disease AND:
• • Platelet count <50×10^9/L AND
• • Scheduled for procedure with bleeding risk (e.g., GI endoscopy, liver biopsy, bronchoscopy, dental procedure) AND
• • Would require platelet transfusion unless platelet counts increase from baseline
• - OR another FDA labeled or compendia-supported indication for agent and route

Approval duration

1 month for thrombocytopenia with chronic liver disease; 6 months for all other indications