Mulpleta (lusutrombopag) — Blue Cross Blue Shield of New Mexico

Initial criteria

• The patient has a baseline platelet count < 50 × 10^9/L
• The patient is scheduled for a procedure with risk of bleeding (e.g., gastrointestinal endoscopy, liver biopsy, bronchoscopy, dental procedure)
• The patient would require platelet transfusion unless platelet counts are increased from baseline prior to therapy
• OR the patient has another FDA-labelled indication for the agent and route
• OR the patient has another indication supported in compendia for the agent and route