- Step Therapy: Pulmonary Arterial Hypertension:
ST Single Generic
- Prior Authorization: Pulmonary Arterial Hypertension:
Duration: 1 plan year
- 1. Approved Indications: a. Confirmed diagnosis of PAH (WHO Group l). Authorization Limit: Length of Benefit.
- Pulmonary Arterial Hypertension:
Duration: 1 plan year
Specialist Required: Yes
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