Pulmonary Arterial Hypertension
Prior authorization is required for the pulmonary arterial hypertension medications in this policy, and the requested medication may be considered medically necessary when all initial criteria are met. For pulmonary arterial hypertension (WHO Group 1), the criteria include right heart catheterization confirmation with mean pulmonary arterial pressure greater than 20 mmHg, pulmonary capillary wedge pressure less than 15 mmHg, and pulmonary vascular resistance of at least 2 Wood units, along with WHO functional class II or greater. Winrevair (sotatercept-csrk) is considered not medically necessary because its place in therapy has not yet been addressed in clinical practice guidelines, and Opsynvi (macitentan-tadalafil), Tadliq (tadalafil oral suspension), Tyvaso DPI (treprostinil inhalation powder) and Yutrepia (treprostinil inhalation powder) are considered not medically necessary as other formulary options exist.