Doptelet tablet (avatrombopag) — Highmark

Initial criteria

• age 6 to <18 years with diagnosis of persistent or chronic immune thrombocytopenia (ICD-10: D69.3) OR age ≥ 18 years with diagnosis of chronic immune thrombocytopenia (ICD-10: D69.3)
• therapeutic failure, contraindication, or intolerance to corticosteroid therapy OR immunoglobulin therapy OR therapeutic failure after splenectomy
• platelet count < 50 x 10^9/L with significant mucous membrane bleeding OR ≥1 risk factor for bleeding (e.g., hypertension, peptic ulcer disease, vigorous lifestyle) OR platelet count ≤ 30 x 10^9/L

Reauthorization criteria

• positive clinical response to therapy

Approval duration

12 months