Alvaiz — Highmark
Thrombocytopenia in patients with chronic hepatitis C to allow initiation and maintenance of interferon-based therapy
Preferred products
- generic eltrombopag olamine
Initial criteria
- Alvaiz is being used to achieve target platelet counts to initiate or maintain interferon therapy in patients with Hepatitis C
- platelet count < 75 x 10^9/L
- therapeutic failure, contraindication, or intolerance to plan-preferred generic eltrombopag olamine
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months