Tracleer tablets — Medica
pulmonary arterial hypertension (PAH)
Preferred products
- generic ambrisentan tablets
- Opsumit tablets
- generic bosentan tablets
- bosentan tablets for oral suspension
- Tracleer tablets for oral suspension
Initial criteria
- Patient meets the standard Pulmonary Arterial Hypertension − Endothelin Receptor Antagonist Prior Authorization Policy criteria
- Patient has tried generic bosentan tablets
- Patient cannot continue to use generic bosentan tablets due to a formulation difference in the inactive ingredient(s) (e.g., difference in dyes, fillers, preservatives) between the Brand and the bioequivalent product which, per the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
1 year