Alvaiz (eltrombopag) — Blue Cross Blue Shield of Montana

Initial criteria

• For hepatitis C associated thrombocytopenia: intent to raise platelets to initiate interferon therapy with baseline platelet <75 × 10^9/L OR on interferon with risk of discontinuation due to thrombocytopenia
• For severe aplastic anemia: at least 2 baseline blood criteria (neutrophils <0.5 × 10^9/L, platelets <30 × 10^9/L, reticulocytes <60 × 10^9/L) AND 1 marrow criterion (severe hypocellularity <25% OR moderate 25–50% with hematopoietic cells <30% of residual) AND ONE of:
• • Use consistent with stage IV advanced metastatic cancer FDA‑approved condition OR
• • Tried and had inadequate response/intolerance/contraindication to BOTH antithymocyte globulin (ATG) AND cyclosporine
• For persistent or chronic ITP (≥3 months): baseline platelet ≤30 × 10^9/L OR 30–<50 × 10^9/L with symptomatic bleeding/increased risk