Tyvaso DPI — United Healthcare
Pulmonary hypertension associated with interstitial lung disease (WHO Group 3)
Initial criteria
- ALL of the following: Diagnosis confirmed by right heart catheterization AND Interstitial lung disease diagnosed based on diffuse parenchymal lung disease on CT of chest AND Pulmonary hypertension is symptomatic AND Prescribed by or in consultation with cardiologist, pulmonologist, or rheumatologist
Reauthorization criteria
- Documentation of positive clinical response to Tyvaso or Tyvaso DPI therapy (e.g., improved exercise ability)
Approval duration
12 months