Skip to content
The Policy VaultThe Policy Vault

Alvaiz (eltrombopag) — Blue Cross Blue Shield of Texas

immune (idiopathic) thrombocytopenia (ITP), persistent or chronic ≥3 months

Initial criteria

  • Platelet count ≤ 30 x 10^9/L OR 30–50 x 10^9/L with symptomatic bleeding/risk for bleeding
  • AND one of: stage 4 metastatic cancer use consistent with best practices OR inadequate response/intolerance/contraindication to corticosteroids, IVIg/anti-D, splenectomy, or rituximab