Covered Uses: | All FDA approved indications not otherwise excluded from Part D. |
Exclusion Criteria: | |
Required Medical Information: | Coverage is provided for use in combination with two or more PAH therapies when treatment with one PAH agent failed to adequately control the patient’s symptoms. |
Age Restrictions: | |
Prescriber Restrictions: | Coverage is provided in situations where it is being prescribed under the care or referral of a cardiologist or pulmonologist. |
Coverage Duration: | 12 months |
Other Criteria: | Renewal coverage is provided in situations where treatment has provided clinical benefit. |