Tadliq — CareFirst (Caremark)
Pulmonary arterial hypertension (PAH)
Preferred products
- tadalafil
Initial criteria
- Medication must be prescribed by or in consultation with a pulmonologist or cardiologist for diagnosis of PAH.
- For PAH: Member has PAH defined as WHO Group 1 class of pulmonary hypertension.
- PAH was confirmed by either of the following:
- Pretreatment right heart catheterization with ALL of the following results: mean pulmonary arterial pressure (mPAP) > 20 mmHg, pulmonary capillary wedge pressure (PCWP) ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 2 Wood units (for pediatric members, PVRI > 3 Wood units × m² acceptable).
- For infants < 1 year of age, PAH may be confirmed by Doppler echocardiogram if right heart catheterization cannot be performed.
- For Secondary Raynaud’s phenomenon: Member has had an inadequate response to one of the following—calcium channel blockers, angiotensin II receptor blockers, selective serotonin reuptake inhibitors, alpha blockers, angiotensin-converting enzyme inhibitors, or topical nitrates.
Reauthorization criteria
- Member is currently receiving a tadalafil product through a paid pharmacy or medical benefit, and experiencing benefit from therapy as evidenced by disease stability or improvement.
Approval duration
12 months