UPTRAVI (PDF)
Clinical policy governing medical necessity criteria, initial and continuation approval requirements, dosing limits, formulation-specific rules, contraindications, appendix therapeutic alternatives, and approval durations for Uptravi (selexipag) across Commercial, HIM, and Medicaid lines of business.
1Q 2026 annual review clarified maximum dose for concomitant administration with CYP2C8 inducers; clarified requirement for titration plan is for oral Uptravi; 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.
1Q 2024 annual review added IV Uptravi 1800 mcg/10 mL formulation and criteria for use per prescribing information.
Revised approval duration for Commercial line of business to 12 months or duration of request, whichever is less (prior: length of benefit).
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.