ORENITRAM (treprostinil)

ORENITRAM (treprostinil)

SELF ADMINISTRATION-ORAL 

Indications of Prior Authorization:

• Indicated in adults for the treatment of pulmonary arterial hypertension (PAH) World Health Organization (WHO) Group 1 to improve exercise capacity.

Patients must meet the following criteria for the indication(s) above:

• Patient is 18 of years or older, AND
• Diagnosis of WHO Group 1 PAH confirmed by chart note documentation, AND 
• Prescribed by or in consultation with a cardiologist or pulmonologist, AND
• Patient has had a right heart catheterization with results confirming diagnosis of WHO Group 1 PAH confirmed by chart note documentation, AND
• Patient has tried two oral therapies for PAH from other categories (either alone or in combination) each for ≥ 60 days: PDE5 Inhibitors (e.g. Revatio, Adcirca), ERA (e.g. Tracleer, Letairis, or Opsumit), or Adempas, OR
• Patient is receiving or has received prostacyclin therapy for PAH in the past (e.g. Tyvaso, Ventavis, Remodulin, or epoprostenol injection-Flolan, Veletri) or a prostacyclin receptor agonist (e.g. Uptravi) for PAH. 

Dosing:

• 0.25 mg by mouth every 12 hours with food or 0.125 mg every 8 hours with food; may increase dose in increments of 0.25 mg or 0.5 mg every 1 hours or 0.125 mg every 8 hours every 3-4 days as tolerated.

Approval: 

• 1 year