ND Committee Review
Internal Medical Policy Committee 11-19-2020 Annual review, no clinical content change
Internal Medical Policy Committee 1-19-2021 Documentation confirming the results of the right heart catheterization diagnosing PAH is now a criteria for all drug approvals. An exception may be made for pediatric individuals,
and
- Updated
Combination therapy criteria.
Internal Medical Policy Committee 11-23-2021
- Clarified
medical versus pharmacy benefit drugs in policy
Internal Medical Policy Committee 3-23-2022 Updated description,
- Updated
criteria;
and
- Added
reauthorization criteria;
and
- Removed
K0455; K0730; and S0155 from the policy;
and
- Updated
experimental/investigational statement;
and
- Updated
professional statement and societal positions
Internal Medical Policy Committee 9-28-2022 -
Effective October 01, 2022
- Added
Tyvaso DPI, J3535, to the policy
Internal Medical Policy Committee 9-12-2023
- Annual review,
no clinical content change
Internal Medical Policy Committee 3-19-2024
Effective April 01, 2024
- Added
Tadliq (tadalafil) and Liqrev (sildenafil) to the pharmacy benefit list
- Removedpharmacy drug procedure codes.
Internal Medical Policy Committee 7-16-2024
Effective August 01, 2024
- Added
macitentan-tadalafil (Opsynvi), sotatercept-csrk (Winrevair) to the pharmacy benefit list
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024