Sildenafil injection (Revatio)

Revatio (sildenafil) injection is covered only for FDA‑approved treatment of WHO Group I pulmonary arterial hypertension to improve exercise ability in patients with idiopathic PAH or PAH associated with connective tissue disease (NYHA Class II or III); off‑label uses and other WHO groups are excluded. Key requirements: right heart catheterization–confirmed diagnosis, documented NYHA Class II/III and disease etiology, and no concurrent nitrate or riociguat (Adempas) use.

"Current medication list or clinical notes documenting absence of concurrent nitrate medications and absence of Adempas (riociguat) use."

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