Alvaiz (eltrombopag choline tablets – Teva) — Cigna

Initial criteria

• Patient is age ≥ 18 years
• Patient has low platelet counts at baseline (pretreatment)
• Patient will be receiving interferon-based therapy for chronic hepatitis C
• The medication is prescribed by or in consultation with a gastroenterologist, a hepatologist, or a physician who specializes in infectious diseases

Approval duration

1 year