Cablivi (caplacizumab-yhdp) — Highmark
acquired thrombotic thrombocytopenic purpura (aTTP)
Initial criteria
- age ≥ 18 years
- prescribed by or in consultation with a hematologist
- diagnosis of acquired thrombotic thrombocytopenic purpura (aTTP) (ICD-10: D69.3)
- Cablivi was started in an inpatient setting in conjunction with BOTH plasma exchange AND immunosuppressive therapy (systemic corticosteroids or rituximab)
- total treatment duration will be limited to 58 days beyond the last therapeutic plasma exchange
Reauthorization criteria
- request is for a new episode requiring re-initiation of plasma exchange for treatment of aTTP
- member has not experienced more than 2 recurrences of aTTP while on Cablivi after the initial course of therapy
Approval duration
up to 60 days following the last plasma exchange (initial); up to 60 days for reauthorization; maximum of three courses per lifetime