Alvaiz — United Healthcare

Initial criteria

• Diagnosis of severe aplastic anemia
• One of the following: (a) Used in combination with standard immunosuppressive therapy (e.g., Atgam [antithymocyte globulin equine], Thymoglobulin [antithymocyte globulin rabbit], cyclosporine) OR (b) History of failure, contraindication, or intolerance to at least one course of immunosuppressive therapy (e.g., Atgam [antithymocyte globulin equine], Thymoglobulin [antithymocyte globulin rabbit], cyclosporine)

Reauthorization criteria

• Documentation of positive clinical response to Promacta or Alvaiz therapy

Approval duration

12 months