Revatio oral powder for suspension — United Healthcare
Pulmonary arterial hypertension (WHO Group 1)
Initial criteria
- EITHER: (ALL of the following: Pulmonary arterial hypertension is symptomatic AND Diagnosis confirmed by right heart catheterization) OR Patient currently on any therapy for pulmonary arterial hypertension
- AND Patient unable to ingest a solid dosage form (tablet/capsule) due to age OR oral-motor difficulties OR dysphagia
- AND Prescribed by or in consultation with cardiologist, pulmonologist, or rheumatologist
Reauthorization criteria
- Documentation that patient is receiving clinical benefit to therapy
- Patient remains unable to ingest a solid dosage form due to age OR oral-motor difficulties OR dysphagia
Approval duration
12 months