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Tavalisse — Blue Cross Blue Shield of Alabama

other FDA labeled or compendia supported indications

Initial criteria

  • - Chronic (≥12 months) ITP AND:
  • • Platelet ≤30×10^9/L OR platelet >30×10^9/L but <50×10^9/L with symptomatic bleeding/increased risk
  • • ONE of:
  • - Tried/inadequate response or intolerance/contraindication to corticosteroids
  • - Tried/inadequate response to another thrombopoietin receptor agonist (e.g., Doptelet, Nplate, Promacta)
  • - Tried/inadequate response to IVIg or Anti-D
  • - Inadequate response to splenectomy
  • - Tried/inadequate response to rituximab
  • - OR another FDA labeled or compendia-supported indication
  • - AND patient age within or supported by FDA labeling
  • - AND NOT used in combination with another agent in this program (unless Nplate for HS-ARS)
  • - AND no FDA labeled contraindications