Tyvaso DPI (treprostinil oral inhalation powder – MannKind/United Therapeutics) — Cigna

Initial criteria

• Patient has a diagnosis of WHO Group 1 pulmonary arterial hypertension (PAH); AND
• Patient meets ONE of the following (a or b): a) Patient is in Functional Class III or IV; OR b) Patient is in Functional Class II and meets ONE of the following [(1) or (2)]: (1) Patient has tried or is currently receiving one oral agent for PAH; OR (2) Patient has tried one inhaled or parenteral prostacyclin product for 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
• Medication is prescribed by or in consultation with a cardiologist or pulmonologist

Reauthorization criteria

• Patient has a diagnosis of WHO Group 1 pulmonary arterial hypertension (PAH); AND
• Patient has had a right heart catheterization prior to starting therapy that confirms WHO Group 1 PAH; AND
• Medication is prescribed by or in consultation with a cardiologist or pulmonologist

Approval duration

1 year