Pulmonary Arterial Hypertension - Adempas Prior Authorization Policy
This policy governs prior authorization requirements for Adempas (riociguat) for Cigna-administered health benefit plans, covering FDA-approved indications for CTEPH and WHO Group 1 PAH and specifying required documentation and prescriber specialty.
No material clinical or coverage changes in this revision.
Coverage Criteria for Adempas (riociguat)
FDA-Approved Indication Criteria
Covered when ALL of the following are met for each indication group
Documentation as required; prescriber specialty required
PAH (WHO Group 1) Approve for 1 year
- A) Initial Therapy: i. Diagnosis of WHO Group 1 PAH; AND ii. BOTH (a) patient has had a right heart catheterization [documentation required]; AND (b) RHC results confirm WHO Group 1 PAH; AND iii. Medication prescribed by or in consultation with a cardiologist or pulmonologist.
Initial therapy requirements
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