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Medical Information: Call 1-877-522-2950 or send requests directly to: DrugInformation@unither.com. Adverse Events: To report a suspected adverse reaction (ADR) to United Therapeutics, please send ADR information to DrugSafety@unither.com, or by faxing the ADR information to 1-919-313-1297, or to report ADRs to the FDA, ADR information can be submitted at 1-800-FDA-1088 or www.fda.gov/medwatch.
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Thank you for your interest in prescribing Remodulin® (treprostinil) injection. This referral form has recently been revised to include the Remunity® Pump for Remodulin, a new subcutaneous delivery pump option for your patients.
United Therapeutics is committed to ensuring the best experience for you and your patients through education and support. To learn more about the pump and considerations prior to prescribing, please request additional information or a visit from a representative using the form below.
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iAssist allows healthcare providers (HCPs) to submit electronic prescriptions and referral forms, perform advanced benefit verifications, submit real-time electronic prior authorizations, obtain patient electronic consent, and track patient adherence to therapy through portal notifications.
Tyvaso Referral Form
Download
Tyvaso Sample Referral Form for PH-ILD
Tyvaso Veterans Affairs Referral Form
Prior Authorization Checklist
Sample Statement of Medical Necessity for PH-ILD
Sample Appeal Letter for PH-ILD
Request for Support Form
If not, check The United Therapeutics Resource Library.
TYVASO (treprostinil) is a prostacyclin mimetic indicated for the treatment of pulmonary hypertension associated with interstitial lung disease (PH-ILD; WHO Group 3) to improve exercise ability. The study establishing effectiveness predominately included patients with etiologies of idiopathic interstitial pneumonia (IIP) (45%) inclusive of idiopathic pulmonary fibrosis (IPF), combined pulmonary fibrosis and emphysema (CPFE) (25%), and WHO Group 3 connective tissue disease (22%).
WARNINGS AND PRECAUTIONS
DRUG INTERACTIONS/SPECIFIC POPULATIONS
ADVERSE REACTIONS
Pulmonary Hypertension Associated with ILD (WHO Group 3) In a 16-week, placebo-controlled study (INCREASE) of 326 patients with PH-ILD (WHO Group 3), adverse events were similar to the experience in studies of PAH. The most common adverse reactions seen with TYVASO in ≥4% of PAH patients and more than 3% greater than placebo in the placebocontrolled study (TRIUMPH I) were cough (54% vs 29%), headache (41% vs 23%), throat irritation/pharyngolaryngeal pain (25% vs 14%), nausea (19% vs 11%), flushing (15% vs <1%), and syncope (6% vs <1%). In addition, adverse reactions occurring in ≥4% of patients were dizziness and diarrhea.
Please see Full Prescribing Information, the TD-100 and TD-300 TYVASO® Inhalation System Instructions for Use manuals, and other additional information at www.tyvaso.com or call 1-877-UNITHER (1-877-864-8437).