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HCPCS/CPT J2796, Injection, romiplostim, 10 micrograms | No Prior Auth

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`J2796`, Injection, romiplostim, 10 micrograms

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

HS-ARS coverage criterion for Romiplostim
ITP indication requiring insufficient response to standard therapies
Romiplostim may be medically necessary to increase survival in adults and pediatric individuals (including term neonates) acutely exposed to myelosuppressive doses of radiation (HS-ARS).
Romiplostim may be medically necessary for the treatment of thrombocytopenia in adults with ITP who had insufficient response to corticosteroids, immunoglobulins, or splenectomy; or pediatric patients 1 year and older with ITP for at least 6 months with insufficient response to corticosteroids, immunoglobulins, or splenectomy.
Romiplostim is medically necessary for treatment of thrombocytopenia due to immune thrombocytopenia (ITP) in adults with insufficient response to corticosteroids, immunoglobulins, or splenectomy, or in pediatric patients 1 year and older with ITP for at least 6 months and insufficient response to those therapies.
Romiplostim is medically necessary for treatment of immune thrombocytopenia (ITP) in adults with insufficient response to corticosteroids, immunoglobulins, or splenectomy; or in pediatric patients aged 1 year and older with ITP for at least 6 months and insufficient response to these therapies.

4 Active Policies

BCBSIL-RX501.157, Romiplostim

BCBSMT-RX501.157, Romiplostim

BCBSNM-RX501.157, Romiplostim

BCBSOK-RX501.157, Romiplostim

Related Codes

J2802(4 policies)

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