Promacta (eltrombopag) — Blue Cross Blue Shield of Texas

Initial criteria

• At least 2 baseline blood criteria: neutrophils < 0.5 x 10^9/L, platelets < 30 x 10^9/L, reticulocyte < 60 x 10^9/L
• Marrow hypocellularity severe (<25%) or moderate (25-50%) with hematopoietic cells <30%
• AND one of: first-line in combination with ATG + cyclosporine OR stage 4 metastatic cancer use consistent with best practices OR inadequate response/intolerance/contraindication to both ATG and cyclosporine