Orenitram (treprostinil extended-release tablets) — Medica

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
• Patient meets ONE of the following (a or b): (a) has tried or is currently receiving at least one oral medication for PAH from the following categories (each for ≥ 60 days): one phosphodiesterase type 5 inhibitor, one endothelin receptor antagonist, or Adempas (riociguat); OR (b) is receiving or has received one PAH prostacyclin therapy or prostacyclin receptor agonist (i.e., Uptravi [selexipag]); AND
• 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; AND results confirm the diagnosis of WHO Group 1 PAH; AND
• Medication is prescribed by or in consultation with a cardiologist or a pulmonologist

Approval duration

1 year