- Prior Authorization: Pulmonary Arterial Hypertension:
Duration: 1 plan year
- 1. Health Net Approved Indications and Usage Guidelines: A. Confirmed diagnosis of PAH (WHO Group 1); OR B. Confirmed diagnosis of CTEPH (WHO Group 4) after surgical treatment or inoperable CTEPH. 2. Coverage is Not Authorized For: a. Non-FDA approved indications, which are not listed in the Health Net Approved Indications and usage guidelines section unless there is sufficient documentation of efficacy and safety in the published literature. b. Patients on concomitant phosphodiesterase (PDE) inhibitors or nitrates. 3. Recommended Authorization Limit: Length of benefit.
- Pulmonary Arterial Hypertension:
Duration: 1 plan year
Specialist Required: Yes
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