Promacta (eltrombopag olamine) — Highmark
first-line treatment of severe aplastic anemia
Preferred products
- generic eltrombopag olamine
Initial criteria
- age ≥ 2 years
- diagnosis of severe aplastic anemia (ICD-10: D61.9)
- used in combination with at least two immunosuppressive therapies (e.g., cyclophosphamide, anti-thymocyte globulin)
- if request is for brand Promacta, therapeutic failure or intolerance to generic eltrombopag olamine