Pharmacy Prior Authorization Criteria

Pulmonary Arterial Hypertension Agents

Indications for Prior Authorization

Adcirca (tadalafil) Tablets, Alyq (tadalafil) Tablets, Tadliq (tadalafil) Oral Suspension

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of pulmonary arterial hypertension (PAH) (World Health Organization [WHO] Group I) to improve exercise ability. Studies establishing effectiveness included predominately patients with New York Heart Association (NYHA) Functional Class II–III symptoms and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (23%).

Adempas (riociguat) Tablets

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for treatment of adults with PAH (WHO Group I) to improve exercise capacity, WHO Functional Class, and to delay clinical worsening. Efficacy was shown in patients on riociguat monotherapy or in combination with endothelin receptor antagonists or prostanoids. Studies establishing effectiveness included predominantly patients with WHO Functional Class II to III and etiologies of idiopathic or heritable PAH (61%) or PAH associated with connective tissue diseases (25%).

• For diagnosis of Chronic-Thromboembolic Pulmonary Hypertension (CTEPH)
  Indicated for treatment of adults with persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH), (WHO Group 4) after surgical treatment, or inoperable CTEPH, to improve exercise capacity and WHO Functional Class.

Flolan (epoprostenol sodium) Injection

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to improve exercise capacity. Studies establishing effectiveness included predominantly (97%) patients with NYHA Functional Class III-IV symptoms and etiologies of idiopathic or heritable PAH (49%) or PAH associated with connective tissue diseases (51%).

Letairis (ambrisentan) Tablets

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to 1) improve exercise ability and delay clinical worsening and 2) in combination with tadalafil to reduce the risks of disease progression and hospitalization for worsening PAH, and to improve exercise ability.

  Studies establishing effectiveness included predominantly patients with WHO Functional Class II-III symptoms and etiologies of idiopathic or heritable PAH (60%) or PAH associated with connective tissue diseases (34%).

Liqrev (sildenafil) suspension

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of pulmonary arterial hypertension (PAH) (World Health Organization [WHO] Group I) in adults to improve exercise ability and delay clinical worsening.

Opsumit (macitentan) Tablets

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to reduce the risks of disease progression and hospitalization for PAH.

  Effectiveness was established in a long-term study in PAH patients with predominantly WHO Functional Class II-III symptoms treated for an average of 2 years. Patients had idiopathic and heritable PAH (57%), PAH caused by connective tissue disorders (31%), and PAH caused by congenital heart disease with repaired shunts (8%).

Orenitram (treprostinil) Tablets

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to delay disease progression and to improve exercise capacity.

  The studies that established effectiveness included predominately patients with WHO functional class II-III symptoms and etiologies of idiopathic or heritable PAH (66%) or PAH associated with connective tissue disease (26%).

Opsynvi (macitentan/ tadalafil) Tablets

• For diagnosis of Pulmonary Arterial Hypertension
  Indicated for the chronic treatment of adults with pulmonary arterial hypertension (PAH, WHO Group I and WHO Functional Class (FC) II–III). Macitentan reduces the risk of clinical worsening events and hospitalization. Tadalafil improves exercise ability.

Remodulin (treprostinil sodium) Injection

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to diminish symptoms associated with exercise. Studies establishing effectiveness included patients with NYHA Functional Class II-IV symptoms and etiologies of idiopathic or heritable PAH (58%), PAH associated with congenital systemic-to-pulmonary shunts (23%), or PAH associated with connective tissue diseases (19%).

  Indicated to diminish the rate of clinical deterioration in patients with PAH requiring transition from epoprostenol. Consider the risks and benefits of each drug prior to transition.

Revatio (sildenafil) Injection, Tablets, Oral Suspension

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I): 1) In adults to improve exercise ability and delay clinical worsening. 2) in pediatric patients 1 to 17 years old to improve exercise ability and, in pediatric patients too young to perform standardized exercise testing, pulmonary hemodynamics thought to underlie improvements in exercise.

Tracleer (bosentan) Tablets, Tablets for Suspension

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group I): 1) In adults to improve exercise ability and to decrease clinical worsening. Studies establishing effectiveness included predominantly patients with WHO Functional Class II-IV symptoms and etiologies of idiopathic or heritable PAH (60%), PAH associated with connective tissue diseases (21%), and PAH associated with congenital heart disease with left-to right shunts (18%). 2) In pediatric patients aged 3 years and older with idiopathic or congenital PAH to improve pulmonary vascular resistance (PVR), which is expected to result in an improvement in exercise ability.

Tyvaso (treprostinil) Inhalation Solution, Tyvaso (treprostinil) DPI Inhalation Powder

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to improve exercise ability. Studies establishing effectiveness included predominately patients with NYHA Functional Class III symptoms and etiologies of idiopathic or heritable PAH (56%) or PAH associated with connective tissue diseases (33%).

  The effects diminish over the minimum recommended dosing interval of 4 hours; treatment timing can be adjusted for planned activities.

  While there are long-term data on use of treprostinil by other routes of administration, nearly all controlled clinical experience with inhaled treprostinil has been on a background of bosentan (an endothelin receptor antagonist) or sildenafil (a phosphodiesterase type 5 inhibitor). The controlled clinical experience was limited to 12 weeks in duration.

• For diagnosis of Pulmonary Hypertension Associated with Interstitial Lung Disease (ILD)
  Indicated for the treatment of pulmonary hypertension associated with ILD (PH-ILD; WHO Group 3) to improve exercise ability. The study establishing effectiveness predominately included patients with etiologies of idiopathic interstitial pneumonia (IIP) (45%) inclusive of idiopathic pulmonary fibrosis (IPF), combined pulmonary fibrosis and emphysema (CPFE) (25%), and WHO Group 3 connective tissue disease (22%).

Veletri (epoprostenol) Injection

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of pulmonary arterial hypertension (PAH) (WHO Group I) to improve exercise capacity. Studies establishing effectiveness included predominantly patients with NYHA Functional Class III-IV symptoms and etiologies of idiopathic or heritable PAH or PAH associated with connective tissue diseases.

Ventavis (iloprost) Inhalation Solution

• For diagnosis of Pulmonary Arterial Hypertension (PAH)
  Indicated for the treatment of PAH (WHO Group I) to improve a composite endpoint consisting of exercise tolerance, symptoms (NYHA Class), and lack of deterioration. Studies establishing effectiveness included predominately patients with NYHA Functional Class III-IV symptoms and etiologies of idiopathic or heritable PAH (65%) or PAH associated with connective tissue diseases (23%).

Uptravi (selexipag) Tablets and Injection

• For diagnosis of Pulmonary Arterial Hypertension
  Indicated for the treatment of PAH (WHO Group I) to delay disease progression and reduce the risk of hospitalization for PAH. Effectiveness was established in a long-term study in PAH patients with WHO Functional Class II-III symptoms. Patients had idiopathic and heritable PAH (58%), PAH associated with connective tissue disease (29%), PAH associated with congenital heart disease with repaired shunts (10%).

Winrevair (sotatercept-csrk) Injection

• For diagnosis of Pulmonary Arterial Hypertension
  Indicated for the treatment of adults with pulmonary arterial hypertension (PAH, WHO Group I) to increase exercise capacity, improve WHO functional class (FC) and reduce the risk of clinical worsening events.

Criteria

Generic Alyq tablet, Generic tadalafil tablet, Adempas tablet, Brand Flolan injection, Generic epoprostenol injection, Generic ambrisentan tablet, Opsumit tablet, Orenitram tablet, Generic treprostinil injection, Generic sildenafil tablet, Generic bosentan tablet, Tracleer tablet for suspension, Tyvaso inhalation solution, Tyvaso Refill inhalation solution, Tyvaso Starter inhalation solution, Tyvaso DPI, Veletri injection, or Ventavis inhalation solution

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Brand Adcirca tablet, Tadliq oral suspension

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Trial and failure or intolerance to generic tadalfil

Brand Letairis tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Trial and failure or intolerance to generic ambrisentan

Opsynvi tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• One of the following:
• Trial and failure, contraindication or intolerance to generic ambrisentan
OR
• Patient is currently being treated with a macitentan-containing product
AND
• Patient is unable to take Opsumit and generic tadalafil separately due to intolerance with Opsumit (e.g., allergy to excipient)
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Brand Remodulin injection

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Trial and failure or intolerance to generic treprostinil

Brand Revatio tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Trial and failure or intolerance to generic sildenafil tablet

Brand Tracleer tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Trial and failure or intolerance to generic bosentan tablet

Brand Revatio injection or Generic sildenafil injection

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Patient is unable to take oral medications [2]
AND
• For Brand Revatio injection, trial and failure or intolerance to generic sildenafil injection

Liqrev, Brand Revatio oral suspension or Generic sildenafil oral suspension

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• For Brand Revatio oral suspension, trial and failure, or intolerance to both of the following:
• Generic sildenafil tablets
• Generic sildenafil oral suspension
AND
• For Liqrev, trial and failure or intolerance to generic sildenafil suspension

Adempas tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

• One of the following:
• Both of the following:
• Diagnosis of inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH)
AND
• CTEPH is symptomatic
OR
• Patient is currently on any therapy for the diagnosis of CTEPH
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Tyvaso inhalation solution, Tyvaso Refill inhalation solution, or Tyvaso Start inhalation solution, Tyvaso DPI

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Hypertension associated with Interstitial Lung Disease

• Diagnosis of pulmonary hypertension associated with interstitial lung disease
AND
• Diagnosis of pulmonary hypertension associated with interstitial lung disease was confirmed by diagnostic test(s) (e.g., right heart catheterization, doppler echocardiogram, computerized tomography imaging)
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Brand Adcirca tablet, Generic tadalafil tablet, Generic Alyq tablet, Tadliq oral suspension, Adempas tablet, Brand Flolan injection, Generic epoprostenol injection, Brand Letairis tablet, Liqrev, Generic ambrisentan tablet, Opsynvi tablet, Opsumit tablet, Orenitram tablet, Brand Remodulin injection, Generic treprostinil injection, Brand Revatio injection, Generic sildenafil injection, Brand Revatio tablet, Generic sildenafil tablet, Brand Revatio oral suspension, Generic sildenafil oral suspension, Brand Tracleer tablet, Generic bosentan tablet, Tracleer tablet for suspension, Tyvaso inhalation solution, Tyvaso Refill inhalation solution, Tyvaso Starter inhalation solution, Tyvaso DPI, Veletri injection, or Ventavis inhalation solution

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of All indications listed above

• Patient demonstrates positive clinical response to therapy
AND
• For Brand Revatio injection, Brand Tracleer, Brand Adcirca, Brand Letairis, Brand Remodulin injection, and Brand Revatio tablet, trial and failure or intolerance to its generic counterpart
AND
• For Brand Revatio oral suspension, trail and failure or intolerance to both of the following:
• Generic sildenafil tablets
• Generic sildenafil oral suspension
AND
• For Tadliq oral suspension, trial and failure or intolerance to generic tadalafil
AND
• For Liqrev, trial and failure or intolerance to generic sildenafil suspension
AND
• For Opsynvi, patient is unable to take Opsumit and generic tadalafil separately due to intolerance with Opsumit (e.g., allergy to excipient)

Uptravi tablet

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• One of the following:
• Both of the following:
• Trial and failure, contraindication, or intolerance to one of the following:
• PDE-5 inhibitor [i.e., Adcirca (tadalafil), Revatio (sildenafil)]
• Adempas (riociguat)
AND
• Trial and failure, contraindication, or intolerance to an endothelin receptor antagonist [e.g., Letairis (ambrisentan), Opsumit (macitentan), Tracleer (bosentan)]
OR
• For continuation of prior therapy
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Uptravi injection

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• One of the following:
• Diagnosis of pulmonary arterial hypertension was confirmed by right heart catheterization [A]
OR
• Patient is currently on any therapy for the diagnosis of pulmonary arterial hypertension
AND
• One of the following:
• Both of the following:
• Trial and failure, contraindication, or intolerance to one of the following:
• PDE-5 inhibitor [i.e., Adcirca (tadalafil), Revatio (sildenafil)]
• Adempas (riociguat)
AND
• Trial and failure, contraindication, or intolerance to an endothelin receptor antagonist [e.g., Letairis (ambrisentan), Opsumit (macitentan), Tracleer (bosentan)]
OR
• For continuation of prior therapy
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist
AND
• Patient is unable to take oral medications [13]

Uptravi tablet/injection

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Patient demonstrates positive clinical response to therapy

Winrevair Injection

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Diagnosis of pulmonary arterial hypertension
AND
• Pulmonary arterial hypertension is symptomatic
AND
• Patient is currently on at least two therapies indicated for the treatment of pulmonary arterial hypertension from the following different mechanisms of action, unless there is a contraindication or intolerance:
• Endothelin receptor antagonists (i.e., Bosentan, ambrisentan or macitentan)
• Phosphodiesterase 5 inhibitors (i.e., Tadalafil or sildenafil)
AND
• Prescribed by or in consultation with one of the following:
• Pulmonologist
• Cardiologist

Winrevair Injection

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Pulmonary Arterial Hypertension

• Patient demonstrates positive clinical response to therapy

P & T Revisions

2024-10-08, 2024-09-16, 2024-06-21, 2024-01-31, 2023-11-01, 2023-10-27, 2023-08-22, 2023-04-04, 2023-02-28, 2023-02-02, 2022-10-04, 2022-07-29, 2022-07-06, 2022-02-03, 2021-11-03, 2021-10-06, 2021-06-02, 2021-02-03, 2020-06-24, 2020-02-05, 2019-12-04, 2019-10-29, 2019-07-01

References

1. Flolan Prescribing Information. GlaxoSmithKline. Research Triangle Park, NC. October 2023.
2. Revatio Prescribing Information. Viatris Specialty LLC. Morgantown, WV. January 2023.
3. Ventavis Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. March 2022.
4. Tyvaso Prescribing Information. United Therapeutics Corp. Research Triangle Park, NC. May 2022.
5. Remodulin Prescribing Information. United Therapeutics Corp. Research Triangle Park, NC. October 2023.
6. Adcirca Prescribing Information. Eli Lilly and Company. Indianapolis, IN. September 2020.
7. Letairis Prescribing Information. Gilead Sciences, Inc. Foster City, CA. August 2019.
8. Tracleer Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. July 2022.
9. Veletri Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. July 2022.
10. Opsumit Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. June 2023.
11. Adempas Prescribing Information. Bayer HealthCare Pharmaceuticals Inc. Whippany, NJ. September 2021.
12. Orenitram Prescribing Information. United Therapeutics Corp. Research Triangle Park, NC. August 2023.
13. Uptravi Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. July 2022.
14. Alyq Prescribing Information. Teva Pharmaceuticals USA, Inc. North Wales, PA. September 2021.
15. Tyvaso DPI Prescribing Information. United Therapeutics Corporation. Research Triangle Park, NC. June 2023.
16. Tadliq Prescribing Information. CMP Pharma, Inc. Farmville, NC. October 2023.
17. Liqrev Prescribing Information. CMP Pharma, Inc. Farmville, NC. April 2023.
18. Winrevair Prescribing Information. Merck Sharp & Dohme LLC. March 2023
19. Opsynvi Prescribing Information. Actelion Pharmaceuticals US, Inc. Titusville, NJ. April 2024.

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End Notes

1. Require right heart catheterization in order to confirm pulmonary arterial hypertension diagnosis: Per clinical consult with cardiologist, PAH specialist, and P&T committee recommendation, February 20, 2014.

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Revision History

• 2024-10-08: For Opsynvi, formulary strategy to add trial of ambrisentan with COT of macitentan bypass.
• 2024-09-16: Added trial through individual components of Opsynvi in both initial and reauthorization criteria.
• 2024-06-21: Added new target drugs to the guideline; Opsynvi and Winrevair.
• 2024-01-31: Annual review: Updated Uptravi criteria, background, and formatting.
• 2023-11-01: Guideline cleanup. Removed duplicate criteria from Revatio oral suspension guideline
• 2023-10-27: Removed all NF criteria, added t/f/i to generic entities for all target drugs that have a generic available in both initial and reauth criteria
• 2023-08-22: GPI clean-up.
• 2023-04-04: Added orenitram titration kit products to guideline.
• 2023-02-28: Added new indication for Revatio in pediatric patients 1 to 17 years old.
• 2023-02-02: Annual review: Background updates.
• 2022-10-04: Added Tadliq to guideline to mirror criteria for Adcirca. Updated background and references.
• 2022-07-29: Updated guideline name to include "PA, NF"
• 2022-07-06: Added Tyvaso DPI. Modified NF criteria for Tracleer. Updated background and references.
• 2022-02-03: Annual review: Criteria updates (Uptravi) and background updates. Includes addition of NF criteria for Adcirca tablet, Remodulin inj, Tracleer tablet, and Letairis tablet.
• 2021-11-03: Added embedded step for Brand Revatio tablet.
• 2021-10-06: Added new Uptravi injection formulation and criteria to guideline.
• 2021-06-02: Added criteria for new indication for Tyvaso and added EHB formulary to the guideline.
• 2021-02-03: Annual review: Updated Uptravi initial and reauthorization criteria and background.
• 2020-06-24: Added embedded step for Brand Tracleer tablet.
• 2020-02-05: Annual review: background updates and GPI replication update for Remodulin (treprostinil).
• 2019-12-04: Orenitram expanded indication: updated background information.
• 2019-10-29: Added formulary strategy and updated background.
• 2019-07-01: Added generic sildenafil oral suspension to guideline and updated background. EAH 7/1/19

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