Alvaiz — CareFirst (Caremark)
Thrombocytopenia post-hematopoietic cell transplant
Initial criteria
- Member is post-allogeneic hematopoietic cell transplant with poor graft function and prolonged thrombocytopenia
Reauthorization criteria
- Authorization of 12 months may be granted if member experiences benefit from therapy (e.g., increased platelet counts, decreased bleeding events, reduced platelet transfusion need)
Approval duration
initial 6 months; continuation 12 months