Doptelet®
Drug - Doptelet® (avatrombopag) [Dova]
June 2019
Therapeutic area - Thrombopoiesis Stimulating Proteins
Approval criteria
Patient must:
- Be 18 years old or older AND
- Have diagnosis of chronic liver disease AND
- Have a platelet count of < 50 x 109/L AND
- Have an invasive procedure scheduled AND
- Be prescribed a dose according to baseline platelet count (10 tablets per 5 days for platelets ≥ 40 x 109/L or 15 tablets per 5 days for platelets < 40 x 109/L) AND
- NOT be scheduled for a thoracotomy, laparotomy, open-heart surgery, craniotomy, or organ resection AND
- NOT be taking Mulpleta AND
- Have avatrombopag scheduled to begin 10 to 13 days prior to the procedure, with the procedure occurring 5 to 8 days following the last dose of avatrombopag
AND
- Date of procedure must be submitted at time of request
Quantity limits
- 5 days (10 or 15 tablets)
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411