You can apply for dual or triple therapy PAH treatment with either:
- one endothelin receptor antagonist (ERA) and one prostanoid
- one ERA and one phosphodiesterase-5 inhibitor (PDE-5i)
- one PDE-5i and one prostanoid
- one ERA, one PDE-5i and one prostanoid
Download and complete the pulmonary arterial hypertension - initial grandfather dual or triple therapy authority application form.
To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.
You can upload this form in HPOS.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.