5.01.522 Advanced Therapies for Pharmacological Treatment of Pulmonary Arterial Hypertension

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The following therapies may be considered medically necessary for the treatment of pulmonary arterial hypertension (PAH/ WHO Group 1):  ambrisentan (LETAIRIS®) oral;  bosentan (TRACLEER®) oral;  epoprostenol sodium (e.g., FLOLAN®) continuous IV infusion;  Iloprost (VENTAVIS®) Inhalation via nebulizer;  macitentan (OPSUMIT®) oral;  riociguat (ADEMPAS®) oral;  sildenafil citrate (e.g., REVATIO®) oral;  tadalafil (ADCIRCA®) oral;  treprostinil sodium (REMODULIN®) Continuous SC infusion, IV infusion or (TYVASO®) inhalation via nebulizer, or Orenitram® oral; and  vardenafil (LEVITRA®) oral.

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5.01.522 Advanced Therapies for Pharmacological Treatment of Pulmonary Arterial Hypertension

The following therapies may be considered medically necessary for the treatment of pulmonary arterial hypertension (PAH/ WHO Group 1):  ambrisentan (LETAIRIS®) oral;  bosentan (TRACLEER®) oral;  epoprostenol sodium (e.g., FLOLAN®) continuous IV infusion;  Iloprost (VENTAVIS®) Inhalation via nebulizer;  macitentan (OPSUMIT®) oral;  riociguat (ADEMPAS®) oral;  sildenafil citrate (e.g., REV...

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تاریخ انتشار 2016