Riociguat (Adempas) (PDF)
Defines medical necessity criteria, quantity/dosing limits, approval durations, prescriber requirements, and exclusions for riociguat (Adempas) for commercial, HIM, and Medicaid lines of business within Centene-affiliated health plans.
Added requirement that request does not exceed health-plan approved quantity limit.
Extended Medicaid and HIM initial approval duration from 6 months to 12 months for this maintenance medication for a chronic condition.
Revised approval duration for Commercial line of business to 12 months or duration of request, whichever is less (prior change noted earlier).
Appendix B updated to remove commercially unavailable branded products and clarify dosing regimens and off-label drugs.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.