Limited coverage drugs – selexipag
Last updated on September 26, 2024
|
Generic name |
selexipag |
|
|---|---|---|
|
Strength |
200 mcg, 400 mcg, 600 mcg, 800 mcg, 1,000 mcg, 1,200 mcg, 1,400 mcg, 1,600 mcg |
|
|
Form |
tablet |
|
|
Special Authority criteria |
Approval period |
|---|---|
|
For the long-term treatment of idiopathic pulmonary arterial hypertension (PAH), heritable PAH, PAH associated with connective tissue disorders, and PAH associated with congenital heart disease in adults who meet ALL of the following criteria:
|
1 year |
Practitioner exemptions
- Designated specialist physicians experienced in the diagnosis and treatment of PAH can enter into a Collaborative Prescribing Agreement to be exempt from completing Special Authority requests
Special notes
- Combination therapy with a prostacyclin such as epoprosterol, or prostacyclin analog therapies such as treprostinil, are not covered by PharmaCare
- The diagnosis of PAH should be confirmed by right heart catheterization
- Conventional therapy (including calcium channel blockers, anticoagulation with warfarin to maintain INR 1.5–2.5, loop diuretics, digoxin, and supplemental oxygen) is considered first-line therapy for select patients with PAH. An inadequate response to maximal appropriate conventional therapy is required for these patients prior to consideration of any other treatment for PAH
- For patients who do not meet established criteria, exceptional cases may be considered where the physician provides additional documentation in a supporting letter. These exceptional case requests will be reviewed by the PAH Drug Benefit Adjudication Advisory Committee
- PharmaCare coverage is limited to two selexipag tablets daily after dose titration