- Quantity Limit: New commercial members to be referred to AcariaHealth.
- Prior Authorization: Pulmonary Arterial Hypertension:
Duration: 1 plan year
- Pulmonary Arterial Hypertension:
Duration: 1 plan year
Specialist Required: Yes
- Step Therapy: Pulmonary Arterial Hypertension:
ST Multiple Generics
- 1. Diagnosis of pulmonary arterial hypertension (PAH) (WHO Group 1). Coverage is Not Authorized For: 1. Patients taking nitrates (e.g., Nitrodur, Nitrobid, Nitrostat, Isordil, Ismo). 2. Patients taking gunylate cyclase (GC) stimulators (e.g., Adempas); 3. Patients taking phosphodiesterase type 5 (PDE5) inhibitors. Authorization Limit: Length of benefit.
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