Promacta — Medica

Initial criteria

• Patient has a platelet count < 30 x 10^9/L (<30,000/mcL) OR has a platelet count < 50 x 10^9/L (<50,000/mcL) AND according to the prescriber, the patient is at increased risk for bleeding
• Patient has tried at least one other therapy (e.g., systemic corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, Nplate, Tavalisse, Doptelet, rituximab) OR patient has undergone splenectomy
• Medication is prescribed by or in consultation with a hematologist

Reauthorization criteria

• According to the prescriber, the patient demonstrates a beneficial clinical response (e.g., increased or maintained platelet counts, decreased frequency of bleeding episodes)
• Patient remains at risk for bleeding complications

Approval duration

initial: 3 months; reauth: 1 year