Doptelet (avatrombopag) — CareFirst (Caremark)
Thrombocytopenia in chronic liver disease
Initial criteria
- Member has an untransfused platelet count of less than 50x10^9/L taken within 14 days of the request
- Member is scheduled to undergo a procedure
Reauthorization criteria
- Continuation of therapy, defined as use beyond the initial approval for the same procedure, is not approvable
- All members (including new members) requesting authorization due to newly scheduled procedure must meet all initial authorization criteria
Approval duration
30 days