Adempas — United Healthcare
Chronic thromboembolic pulmonary hypertension (CTEPH) (WHO Group 4)
Initial criteria
- EITHER: ALL of the following: Diagnosis of inoperable or persistent/recurrent CTEPH AND CTEPH is symptomatic AND Prescribed by or in consultation with cardiologist, pulmonologist, or rheumatologist
- OR: BOTH of the following: Patient currently on any therapy for CTEPH AND Prescribed by or in consultation with cardiologist, pulmonologist, or rheumatologist
Reauthorization criteria
- Documentation that patient is receiving clinical benefit to Adempas therapy
Approval duration
12 months