Forms and Documents

Adcirca® (tadalafil) forms

Adcirca Referral Form

Adcirca Veterans Affairs Referral Form

Prior Authorization Checklist

Sample Statement of Medical Necessity

Sample Appeal Letter

Orenitram® (treprostinil) forms

Orenitram Referral Form

Orenitram Veterans Affairs Referral Form

Prior Authorization Checklist

Sample Statement of Medical Necessity

Sample Appeal Letter

Remodulin® (treprostinil) forms

Remodulin Referral Form

Remodulin Veterans Affairs Referral Form

Prior Authorization Checklist

Sample Statement of Medical Necessity

Sample Appeal Letter

Tyvaso® (treprostinil) forms

Tyvaso Referral Form

Tyvaso Veterans Affairs Referral Form

Prior Authorization Checklist

Sample Statement of Medical Necessity

Sample Appeal Letter