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DrugUptravi® (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


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

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