Opsynvi — Cigna

Initial criteria

• Patient has a diagnosis of World Health Organization (WHO) Group 1 pulmonary arterial hypertension (PAH); AND
• Patient has had a right heart catheterization [documentation required]; AND
• Results of the right heart catheterization confirm the diagnosis of WHO Group 1 PAH; AND
• The medication is prescribed by or in consultation with a cardiologist or a pulmonologist

Reauthorization criteria

• Patient has a diagnosis of World Health Organization (WHO) Group 1 pulmonary arterial hypertension (PAH); AND
• Patient has had a right heart catheterization prior to starting therapy with a medication for WHO Group 1 PAH; AND
• Results of the right heart catheterization confirm the diagnosis of WHO Group 1 PAH; AND
• The medication is prescribed by or in consultation with a cardiologist or a pulmonologist

Approval duration

1 year