Ventavis - Tyvaso
Drug - Ventavis (inhaled iloprost), Tyvaso (inhaled treprostinil)
Therapeutic area - Pulmonary arterial hypertension
Ventavis is indicated for the treatment of pulmonary arterial hypertension (WHO Group I) in patients with NYHA Class III or IV symptoms.
It must be inhaled via INEB® AAD® (Adaptive Aerosol Delivery) System.
Payment for Ventavis (ilorprost) will be authorized if:
- Patient had an appropriate diagnostic evaluation and has been definitively diagnosed with Pulmonary Arterial Hypertension NYHA class III or IV symptoms AND
- Patient is also taking a calcium channel blocker if he or she tested positive for a vasodilator response OR is not a candidate for calcium channel blocker
Payment for Tyvaso (treprostinil) will be authorized if:
- Patient had an appropriate diagnostic evaluation and has been definitively diagnosed with WHO Group 1 Pulmonary Arterial Hypertension and has NYHA class III symptoms AND
- Patient is also taking a calcium channel blocker if he or she tested positive for a vasodilator response OR is not a candidate for calcium channel blocker AND
- The patient has used Ventavis but PAH symptoms are not maintained with a minimum of 6 times daily dosing with Ventavis
Quantity limits both products
The State will authorize payment of the first fill only.
Pharmacy documentation of benefit and tolerability is required for subsequent fills.
After patient has demonstrated benefit and tolerability for 2 consecutive months, then 30 day supplies are allowed and PA extension up to 6 months.
Rationale for step-thru criteria
Tyvaso is supplied as 2.9 mL ampules, which contain 4 doses. The AWP of each mL is $165.27. The AWP for 2.9mL (one day) is $480, and state cost ~$408. The cost to the state (after discounts and rebates) for a month of therapy is $10,466. This is a little more than twice the cost of Ventavis if Ventavis is dosed 6 times per day. It is about 30% more than Ventavis if Ventavis is dosed 9 times per day.
MHCP Provider Call Center 651-431-2700 or 800-366-5411