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The Policy VaultThe Policy Vault

EltrombopagMedica

Thrombocytopenia in a Patient Post-Allogeneic Transplantation

Initial criteria

  • according to prescriber, patient has poor graft function
  • platelet count < 50 x 10^9/L
  • prescribed by or in consultation with a hematologist, oncologist, or stem cell transplant specialist physician

Reauthorization criteria

  • according to prescriber, patient demonstrated a beneficial clinical response (e.g., increased platelet counts, maintenance of platelet counts, and/or decreased frequency of bleeding episodes)

Approval duration

initial: 3 months; reauth: 6 months