Cablivi (caplacizumab-yhdp) — United Healthcare

Initial criteria

• Diagnosis of acquired thrombotic thrombocytopenic purpura (aTTP)
• Cablivi was initiated as a bolus intravenous injection administered by a healthcare provider in combination with plasma exchange therapy
• Cablivi will be used in combination with immunosuppressive therapy (e.g., corticosteroids)
• Total treatment duration will be limited to 58 days beyond the last therapeutic plasma exchange

Reauthorization criteria

• Request is for a new (different) episode requiring the re-initiation of plasma exchange for the treatment of aTTP (documentation of date of prior episode and documentation date of new episode required)

Approval duration

2 months