Adcirca — Highmark
pulmonary hypertension
Preferred products
- tadalafil
- Alyq
- ambrisentan
- sildenafil
- bosentan oral tablets
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy.
- If request is for brand Adcirca, member has experienced therapeutic failure or intolerance to generic tadalafil or Alyq.
- If request is for brand Letairis, member has experienced therapeutic failure or intolerance to generic ambrisentan.
- If request is for brand Revatio, member has experienced therapeutic failure or intolerance to generic sildenafil.
- If request is for brand Tracleer oral tablets, member has experienced therapeutic failure or intolerance to generic bosentan oral tablets.
Approval duration
12 months