Uptravi

Drug - Uptravi® (sekexipag) [Actelion Pharmaceuticals US, Inc.]

August 2017

Therapeutic area - Pulmonary arterial hypertension

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

Quantity limits

• Tablets (all strengths): 68 tablets per 34 days
• Titration pack: 1 pack

Questions?

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