Access forms and resources
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Getting Started With Doptelet and Doptelet Sprinkle
Gives an overview of the Doptelet and Doptelet Sprinkle access process and the pathway options to initiate treatment from prescription through continuing care.
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Letter of Medical Necessity
Shows a sample letter that can be sent on behalf of patients when submitting a prior authorization request for Doptelet or Doptelet Sprinkle.
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Prior Authorization Resource Guide
Explains general steps in the prior authorization process to help HCP offices get patients started on Doptelet or Doptelet Sprinkle.
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Accessing Doptelet and Doptelet Sprinkle Through Specialty Pharmacies and Distributors
Lists contact information for the specialty pharmacies and distributors that are authorized to dispense or distribute Doptelet and Doptelet Sprinkle.
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Coding Resources
Provides codes to identify appropriate patients and assists with the billing and reimbursement of Doptelet and Doptelet Sprinkle.
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You've Prescribed Doptelet or Doptelet Sprinkle: Now What?
Outlines the process for patients to obtain a prescription for Doptelet or Doptelet Sprinkle from a specialty pharmacy.
Doptelet Connect programs
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Doptelet Connect provides information regarding patient insurance coverage and financial assistance information that may be available to help patients with financial needs. Learn more about Doptelet Connect patient support programs below.
There are 3 ways to enroll a patient:
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Enroll your patients directly through the secure portal
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Download and complete the Prescription Enrollment Form below. After obtaining HCP signatures, submit the completed form 1 of 3 ways: upload it to the portal, fax it to 1-855-686-8729, or email it to DopteletConnect@AssistRx.com
Call Doptelet Connect at 1-833-368-2663
Monday–Friday 8:30 AM–7 PM ET
Doptelet Connect forms
| Doptelet Free Trial Offer*† | The Doptelet Free Trial Offer provides a 15-day supply of Doptelet or Doptelet Sprinkle at no cost, allowing physicians to evaluate a patient’s clinical response to treatment and determine whether it's appropriate. Patient must be 1 year or older, new to Doptelet or Doptelet Sprinkle, and have persistent or chronic ITP. | |
| Doptelet Copay Assistance Program†‡ | The Doptelet Copay Assistance Program is for eligible patients who have commercial prescription insurance. Patients may pay as little as $0 per prescription, and may receive up to a maximum benefit of $15,000 per calendar year. Learn more about how the Doptelet Copay Assistance Program can help lower out-of-pocket costs for eligible patients receiving Doptelet or Doptelet Sprinkle. | |
| Doptelet Bridge Program†§ | The Doptelet Bridge Program can provide a limited supply of Doptelet or Doptelet Sprinkle at no cost to eligible patients experiencing a gap in coverage for treatment. | |
| Doptelet Patient Assistance Program†§ | The Doptelet Patient Assistance Program provides Doptelet or Doptelet Sprinkle at no cost to patients who meet the program eligibility requirements. |
*In order to participate in the Doptelet Free Trial Offer, a patient must be new to therapy and be aged ≥1 year. The patient must be prescribed Doptelet or Doptelet Sprinkle for an approved on-label indication (ITP only) and be under the care of a licensed healthcare provider who is authorized to prescribe medicine in the United States or US Territories, and the patient must reside in the United States or US Territories. Additionally, a patient can only participate in the Doptelet Free Trial Offer once. The offer is void where prohibited by law. Certain rules and restrictions apply. Sobi reserves the right to revoke, rescind, or amend this offer without notice.
†For ages 1-6, patient assistance offerings are subject to product availability for Doptelet Sprinkle.
‡In order to participate in the Doptelet Copay Assistance Program (“Program”), a patient must be aged ≥1 year and have commercial prescription insurance for Doptelet or Doptelet Sprinkle. This Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including (but not limited to) Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. This offer is not valid for patients paying with cash. The Program is void where prohibited by law. Certain rules and restrictions apply. Sobi reserves the right to revoke, rescind, or amend this offer without notice. This Program is not insurance.
§Program subject to eligibility requirements and program terms and conditions.
HCP=healthcare professional; ITP=immune thrombocytopenia.
Doptelet Connect resources
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Doptelet Connect Overview
Summary of the different access and reimbursement support options that help patients access Doptelet or Doptelet Sprinkle.
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Doptelet Connect Process Flow for Healthcare Professional Office
Explains the relationship between the HCP offices and Doptelet Connect and steps each may take during the access and reimbursement process.
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Patient Consent Form
Complete this form if patient’s signature is requested by Doptelet Connect.
See formulary status in your areaII
IICoverage and reimbursement information is provided for your information only and is subject to change. For specific information, please contact the patient’s insurer. Third-party payment for prescription drugs is affected by numerous factors, and Sobi makes no representation or guarantee concerning reimbursement or coverage for Doptelet, Doptelet Sprinkle, or any other service or item.
HCP=healthcare professional; TPO-RA=thrombopoietin receptor agonist.
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Looking for resources?
Access and download helpful materials for your patients and practice.
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Connect with an expert
Get guidance on starting treatment, managing access, and supporting your patients taking Doptelet and Doptelet Sprinkle.
- DOPTELET (avatrombopag) [prescribing information]. Morrisville, NC: AkaRx, Inc; 2025.
- Data on file. MMIT summary export. 2025; Sobi, Inc.