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