generic eltrombopag oral suspension — Medica
any FDA-approved indication(s) per standard Thrombocytopenia – Eltrombopag Products Prior Authorization Policy
Preferred products
- generic eltrombopag tablets
Initial criteria
- Patient meets the standard Thrombocytopenia – Eltrombopag Products Prior Authorization Policy criteria
- AND ONE of the following:
- • Patient has tried generic eltrombopag tablets [documentation required]; OR
- • Patient cannot swallow or has difficulty swallowing tablets
Approval duration
same as duration noted in the standard Thrombocytopenia – Eltrombopag Products Prior Authorization Policy