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Update to Preferred Therapy for Pulmonary Arterial Hypertension Drugs Effective September 1, 2021

Audience: Cardiologists and Pulmonologists

We want to make you aware of an upcoming medical benefit change regarding treatment for pulmonary arterial hypertension (PAH).

Effective September 1, 2021, the generic versions of Remodulin®, Flolan®, and Veletri® will be our preferred products for the treatment of pulmonary arterial hypertension over their brand name counterparts.

Tresprostinil is preferred over brand name Remodulin.

Epoprostenol is preferred over brand name Flolan and Veletri.

All of the above listed products already currently require prior authorization.

These changes will impact new starts only for Medicare members and existing users on recertification for all other lines of business, including Medicaid Managed Care members.

This policy change was reviewed and approved by our Pharmacy & Therapeutics Committee, which includes local physicians and pharmacists who are not employed by our Health Plan.

Prescribing & Billing Requirements

To ensure accurate prescribing and correct claim submissions, please follow the requirements outlined in the table and share this important information with your billing office/billing service and anyone within your practice who should be aware.

Prescribing Requirements

Preferred Generic

HCPCS Code

NDC

Non-Preferred Brand Drug

All Lines of Business

Treprostinil

J3285

00703-0666-01

00703-0676-01

00703-0686-01

00703-0696-01

Remodulin

Prior Authorization Required

Epoprostenol

J1325

00703-1985-01

00703-1995-01

62756-0059-40

62756-0060-40

Flolan

Veletri

Prior Authorization Required

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you have questions or concerns, please do not hesitate to contact your Provider Relations representative.

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