Ventavis
Defines prior authorization, quantity limit, specialty pharmacy requirement, clinical criteria for initiation and continuation of Ventavis (for PAH WHO Group 1), required diagnostic confirmation, approval duration, and excluded indications.
Reviewed at Dec P&T, switched from SGM to Custom; effective 1/1/2024
Coverage Summary
Ventavis (iloprost) is FDA-approved for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to improve a composite endpoint of exercise tolerance, symptoms (NYHA Class), and lack of deterioration. All other indications are considered experimental/investigational and not medically necessary. Approvals will be granted for 12 months, and the drug is designated as a specialty medication that must be filled at a contracted specialty pharmacy.
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