Romiplostim (Nplate)

Nplate (romiplostim) is covered for FDA‑approved indications (immune thrombocytopenia and hematopoietic syndrome of acute radiation syndrome) and compendial uses (thrombocytopenia due to myelodysplastic syndrome and chemotherapy‑induced thrombocytopenia); other uses not meeting these indication‑specific criteria are excluded. Coverage requires hematologist/oncologist prescribing or consultation, indication‑specific platelet thresholds (e.g., <30×10^9/L or <50×10^9/L with increased bleeding risk for ITP/MDS; <100×10^9/L for chemotherapy‑induced), prior therapy or splenectomy for ITP, low‑to‑intermediate MDS risk, timing/delay criteria for chemo‑related cases, documentation of acute radiation exposure for HS‑ARS, documented beneficial response for reauthorization, and specified dosing and duration limits (e.g., ≤10 mcg/kg weekly for ITP/CIT, single ≤10 mcg/kg dose for HS‑ARS, ≤1,500 mcg ≤2×/wk for MDS; initial auth generally 3 months except HS‑ARS one dose; reauth per policy).