Nplate — Blue Cross Blue Shield of Alabama

Initial criteria

• - HS-ARS diagnosis
• - OR ITP (if pediatric, duration ≥6 months) 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 immunoglobulins (IVIg or Anti-D)
• - Inadequate response to splenectomy
• - Tried and inadequate response to rituximab
• - OR another FDA labeled or compendia-supported indication for agent and route