IMMEDIATE ACTION REQUIRED - By 2025-10-27 (policy effective date), implement the following: (1) Billing team must update prior authorization workflows in billing system to require prior auth for J2802 (romiplostim injection) for all commercial Aetna plans with mandatory documentation of: specific indication (ITP, HS-ARS, MDS, CIT, or checkpoint inhibitor toxicity), prior therapy failure/intolerance, and current platelet count; (2) Providers must confirm prescriber is a hematologist or oncologist on all romiplostim orders before submitting claims; (3) Update encounter documentation templates to capture: prior treatment history, baseline platelet counts, bleeding symptoms/risk factors, and current platelet response for continuation claims; (4) Implement edit in billing software to deny claims for concurrent use of J2802 with other thrombopoietin agonists (eltrombopag, avatrombopag, lusutrombopag) or spleen tyrosine kinase inhibitors; (5) Configure system to require specific ICD-10 codes (D46.22, D46.c, D46.9, D69.3, D69.49, D69.59, or T45.1x5A-S) matching approved indications; (6) For ITP claims, ensure documentation includes either platelet count <30 x10⁹/L OR platelet count 30-50 x10⁹/L with symptomatic bleeding/bleeding risk; (7) For CIT claims, verify documentation shows either platelet count <100 x10⁹/L for 3-4 weeks post-chemo OR delayed chemotherapy due to thrombocytopenia; (8) For checkpoint inhibitor toxicity, confirm G3 (25,000-50,000/mm³) or G4 (<25,000/mm³) thrombocytopenia with documented corticosteroid failure after 1-2 weeks; (9) Continuation claims require documentation of therapeutic benefit (increased platelets, decreased bleeding, reduced transfusions); (10) Training required for billing and clinical staff on five distinct indications and their unique criteria. CONSEQUENCES: Claims lacking required prior authorization, improper prescriber credentials, missing medical necessity documentation, or concurrent prohibited medications will be denied and require resubmission, delaying payment.