38100 Insurance Policy Changes

Romiplostim (Nplate) (CPB 0768, reviewed 2025-10-27)

Aetna updated its Clinical Policy Bulletin for Romiplostim (Nplate) effective 2025-10-27, establishing medical necessity criteria for five approved indications: Immune Thrombocytopenia (ITP), Hematopoietic Syndrome of Acute Radiation Syndrome (HS-ARS), Myelodysplastic Syndromes (MDS), Chemotherapy-Induced Thrombocytopenia (CIT), and Immune Checkpoint Inhibitor-Related Toxicity. The policy requires hematologist or oncologist prescribing, prohibits concurrent use with other thrombopoietin receptor agonists or spleen tyrosine kinase inhibitors, and specifies distinct initial and continuation criteria with detailed dosing adjustments for adults and pediatrics.