Healthcare Providers Patients & Caregivers

The Referral Process

Referral Process

Referral is sent to ASSIST

ASSIST collects missing information, performs benefit investigation

ASSIST triages referral to preferred Specialty Pharmacy

Specialty Pharmacy verifies coverage

Specialty Pharmacy calls patient, confirms coverage and assistance with patient and insurance, and schedules shipment and nursing services

The ORENITRAM (treprostinil) referral form

Orenitram Referral Form

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Orenitram VA Referral Form

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Important reminder

Let your patient know that after your office submits the referral form, an ASSIST Specialist will call them to verify insurance coverage or to obtain additional information.

It is very important that the patient answers or returns this call, or the approval process could be delayed. You may want to let your patient know that the call will come from Melbourne, Florida, showing an area code of 321.

Questions?

If you have any questions about completing the referral form, contact ASSIST at 1-877-864-8437, Monday - Friday, 8:30am to 7:00pm ET.

Indication

Orenitram is a prostacyclin mimetic indicated for treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to delay disease progression and to improve exercise capacity.

The studies that established effectiveness included predominately patients with WHO functional class II-III symptoms and etiologies of idiopathic or heritable PAH (66%) or PAH associated with connective tissue disease (26%).

IMPORTANT SAFETY INFORMATION FOR ORENITRAM

CONTRAINDICATIONS

Avoid use of Orenitram in patients with severe hepatic impairment (Child Pugh Class C) due to increases in systemic exposure.

WARNINGS AND PRECAUTIONS

Abrupt discontinuation or sudden large reductions in dosage of Orenitram may result in worsening of PAH symptoms.

OThe Orenitram tablet shell does not dissolve. In patients with diverticulosis, Orenitram tablets can lodge in a diverticulum.

ADVERSE REACTIONS

In the 12-week, placebo-controlled, monotherapy study, and an event-driven, placebo-controlled, combination therapy study, adverse reactions that occurred at rates at least 5% higher on Orenitram than on placebo included headache, diarrhea, nausea, vomiting, flushing, pain in jaw, pain in extremity, hypokalemia, abdominal discomfort, and upper abdominal pain.

DRUG INTERACTIONS

Co-administration of Orenitram and the CYP2C8 enzyme inhibitor gemfibrozil increases exposure to treprostinil; therefore, Orenitram dosage reduction may be necessary in these patients.

SPECIFIC POPULATIONS

Animal reproductive studies with Orenitram have shown an adverse effect on the fetus. There are no adequate and well-controlled studies with Orenitram in pregnant women.

It is not known whether treprostinil is excreted in human milk or if it affects the breastfed infant or milk production.

Safety and effectiveness of Orenitram in pediatric patients have not been established.

Use of Orenitram in patients aged 65 years and over demonstrated slightly higher absolute and relative adverse event rates compared to younger patients. Caution should be used when selecting a dose for geriatric patients.

There is a marked increase in the systemic exposure to treprostinil in hepatically impaired patients.

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For additional information please see Full Prescribing Information or call Customer Service at 1-877-UNITHER (1-877-864-8437)

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07/21 US/ASSIST/0119