Ventavis — Medical Mutual

Pulmonary Arterial Hypertension (WHO Group 1)

Initial criteria

Diagnosis of WHO Group 1 pulmonary arterial hypertension (PAH); AND
Agent is prescribed by, or in consultation with, a cardiologist or pulmonologist; AND
Patient is in Functional Class III or IV OR Patient is in Functional Class II AND has tried or is currently receiving one oral agent for PAH (e.g., Tracleer, Letairis, Opsumit, Revatio, Adcirca, Adempas, Orenitram, or Uptravi) OR has tried one inhaled or parenteral prostacyclin product (e.g., Tyvaso, Tyvaso DPI, Ventavis, Remodulin, epoprostenol injection); AND
Patient has had a right heart catheterization; AND
Right heart catheterization results confirm WHO Group 1 PAH

Diagnosis of WHO Group 1 pulmonary arterial hypertension (PAH); AND
Agent is prescribed by, or in consultation with, a cardiologist or pulmonologist; AND
Patient has had a right heart catheterization prior to starting therapy; AND
Right heart catheterization results confirm diagnosis of WHO Group 1 PAH

1 year