Alvaiz — United Healthcare
Chronic hepatitis C-associated thrombocytopenia
Initial criteria
- Diagnosis of chronic hepatitis C-associated thrombocytopenia
- One of the following: (a) Planning to initiate and maintain interferon-based treatment OR (b) Currently receiving interferon-based treatment
Reauthorization criteria
- Documentation of positive clinical response to Promacta or Alvaiz therapy
- Patient is currently on antiviral interferon therapy for treatment of chronic hepatitis C
Approval duration
12 months