Nplate® (romiplostim)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

Injectable auth/billing notes:

Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.

Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.

Code(s): J2796

Benefit: Medical


  • For treatment of chronic immune (idiopathic) thrombocyctopenia (ITP).
  • Starting dose 1 mcg/kg SC weekly. Median dose to achieve response: 2-3 mcg/kg weekly. Max dose 10 mcg/kg weekly. Dose to achieve platelet count above 50 x 109/L (not to normal platelet levels).

Length of initial authorization: 4 injections.

Length of continuation authorization: If platelet count increases to a level sufficient to avoid clinically important bleeding, approved for an additional 4 injections