Winrevair — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Patient has had a right heart catheterization AND results confirmed diagnosis of WHO Group 1 PAH
• Patient is in Functional Class II, III, or IV
• Patient meets ONE of the following:
• a) Currently receiving at least two other PAH therapies from different pharmacologic categories (PDE5i, ERAs, sGCs, prostacyclins) each for > 60 days
• OR
• b) Currently receiving at least one other PAH therapy for > 60 days and is intolerant to combination therapy with PDE5i, ERAs, sGCs, or prostacyclin
• Medication is prescribed by or in consultation with a cardiologist or a pulmonologist

Reauthorization criteria

• Patient has had a right heart catheterization AND results confirmed diagnosis of WHO Group 1 PAH (prior to starting therapy)
• Medication is prescribed by or in consultation with a cardiologist or a pulmonologist

Approval duration

6 months initial, 1 year reauth