Orenitram ER

Drug - Orenitram ER™ (treprostinil extended-release tablet) [United Therapeutics Corp.]

August 2017

Therapeutic area - PAH

Approval criteria

Patient must be 18 years of age or older AND
Uptravi is prescribed by, or in consultation with, a cardiologist or pulmonologist AND
Patient must have a diagnosis of pulmonary arterial hypertension (PAH, WHO Group 1) AND
Patient has WHO Functional Class II-III symptoms AND
Patient is not smoking tobacco products AND
Patient must have tried and failed a calcium channel blocker if they have a positive vasoreactivity test AND
Patient must have tried and failed sildenafil (Revatio) or taladafil (Adcirca) AND
Unless pregnant, patient must have tried and failed ambrisentan or bosentan

MHCP Provider Call Center 651-431-2700 or 800-366-5411