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
- Removed pharmacy 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