Romiplostim

This policy covers coverage of romiplostim (Nplate®) for treatment of immune thrombocytopenia (ITP) in adults and children ≥1 year with an insufficient response to corticosteroids, IVIG, or splenectomy, and for increasing survival after hematopoietic syndrome of acute radiation syndrome (HS‑ARS). Coverage is subject to member benefit plan and state rules (applies to HCSC Ohio members with drug benefits), requires ITP be a diagnosis of exclusion with bleeding risk documented, limits initial dosing (eg, up to 3 mcg/kg weekly with further increases only if platelets <50×10^9/L), and off‑label or non‑FDA uses must be supported by recognized compendia or two peer‑reviewed articles; oncology uses are managed separately and non‑label uses may be investigational.

"Coverage for services and supplies is determined by the member's benefit plan, summary plan description, or contract."