Medicare AdvantagePrior AuthMedium impact
Doptelet® (Avatrombopag) Products (Revised)
Humana·Hematology, Gastroenterology, Pediatrics +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization criteria for Doptelet (avatrombopag) products, effective January 1, 2025. The policy establishes specific approval criteria for three indications: chronic immune thrombocytopenia in adults, thrombocytopenia in chronic liver disease, and persistent/chronic immune thrombocytopenia in pediatrics, with different approval durations and renewal requirements for each.
Action Required
By January 1, 2025: Prior authorization team must implement new Doptelet (avatrombopag) prior authorization requirements for Humana Medicare Advantage members. Update system to verify patient meets specific criteria including platelet count thresholds, diagnosis requirements, and prior treatment failures before approving. Train staff on different approval durations: 3 months initial for all indications, with 6-month renewals for ITP and 3-month renewals for chronic liver disease. Failure to obtain proper prior authorization will result in claim denials.