Your Patients Need Adempas — Here's How to Help Them Get It

As a provider managing patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), you already know that prescribing Adempas (Riociguat) is only the first step. The real challenge often begins when your patient tries to fill the prescription.

Adempas is distributed exclusively through the Adempas REMS program, which limits dispensing to certified specialty pharmacies. Combined with insurance prior authorization requirements and the medication's high cost (~$14,000-$15,000/month), patients frequently face significant barriers to accessing their medication.

This guide offers practical, actionable steps your practice can take to help patients get Adempas more quickly and reliably.

Current Availability

As of early 2026, Adempas is not in shortage. Bayer Healthcare Pharmaceuticals continues to manufacture and distribute Riociguat through its REMS-certified specialty pharmacy network. The access challenges patients experience are structural rather than supply-driven:

• Only REMS-certified specialty pharmacies can dispense
• Prior authorization required by most payers
• High cost creates financial barriers for underinsured patients
• Initial fills require REMS enrollment paperwork completion

For the current shortage status and market context, see our provider shortage briefing.

Why Patients Can't Find Adempas

Understanding the barriers helps your team address them proactively:

REMS Distribution Restrictions

The Adempas REMS program exists because of the medication's boxed warning for embryo-fetal toxicity. Under REMS, prescribers must be certified, pharmacies must be certified, and female patients of reproductive potential must have documented pregnancy tests and use two forms of contraception. This eliminates retail pharmacies from the dispensing chain entirely.

Specialty Pharmacy Processing Times

Initial Adempas fills typically require 7-14 business days for processing. This includes REMS enrollment verification, insurance prior authorization, benefit investigation, and shipping logistics. Refills are faster but still take 3-5 business days.

Insurance Barriers

Most plans classify Adempas under specialty tier with mandatory prior authorization. Some plans require step therapy documentation. Denials and appeals add additional delays. Even when covered, copays on specialty tiers can be prohibitive without assistance.

Patient Knowledge Gaps

Many patients don't understand why their local pharmacy can't fill this prescription or how to navigate the specialty pharmacy process. This leads to frustration, missed doses, and in some cases, therapy discontinuation.

What Providers Can Do: 5 Steps to Improve Access

Step 1: Initiate Specialty Pharmacy Coordination at the Point of Prescribing

Don't send patients home with a prescription and expect them to figure out the specialty pharmacy process on their own. At the point of prescribing:

• Identify which REMS-certified specialty pharmacy you'll use
• Have your staff fax or electronically transmit the prescription directly
• Complete REMS enrollment paperwork with the patient during the office visit
• Ensure pregnancy testing is documented (for applicable patients) before the prescription is sent

This front-loading eliminates the most common source of delays.

Step 2: Submit Prior Authorization Proactively

Don't wait for the insurance company to request documentation. Submit prior authorization with the initial prescription, including:

• Confirmed diagnosis (PAH WHO Group 1 or CTEPH)
• Hemodynamic data (right heart catheterization results)
• WHO functional class
• Documentation of contraindications to surgery (for CTEPH patients)
• Previous therapies tried (if step therapy is required)

Having a PA template for Adempas in your practice saves time on every new prescription.

Step 3: Connect Patients With Financial Assistance

Cost is one of the top reasons patients fail to fill specialty prescriptions. At the time of prescribing, introduce patients to available programs:

• Bayer Aim Patient Support Program (855-423-3672) — copay assistance covering up to 100% of out-of-pocket costs for commercially insured patients; free drug program for uninsured patients
• Patient Access Network (PAN) Foundation (866-316-7263) — copay support for insured patients at 400-500% FPL
• Prescription Hope — medication access for $70/month for qualifying patients

Your clinical coordinator or social worker can streamline enrollment in these programs as part of the prescribing workflow. For a comprehensive list, refer patients to savings programs for Adempas.

Step 4: Use Medfinder to Check Real-Time Availability

Medfinder for Providers allows your practice to check which specialty pharmacies currently have Adempas in stock. This is especially useful when:

• Your usual specialty pharmacy is experiencing a processing delay
• A patient needs an urgent fill and can't wait for standard processing
• You need to verify availability before sending a new prescription

Bookmark medfinder.com/providers for your clinical team and share it with patients as well.

Step 5: Establish a Refill Tracking System

Gaps in Adempas therapy can have serious clinical consequences. Implement a system to track refill timing:

• Flag patients on Adempas in your EHR for proactive refill reminders
• Contact patients 2-3 weeks before their next fill is due to ensure the specialty pharmacy has been contacted
• Document the specialty pharmacy name and contact information in the patient's chart
• Follow up on any reported access issues at each visit

When to Consider Alternatives

If a patient cannot access Adempas despite your best efforts — whether due to insurance denial, cost, or other barriers — it may be appropriate to discuss alternative therapies:

For PAH Patients

• Bosentan (Tracleer) — ERA, available as a generic; lower cost (~$1,500-$3,000/month)
• Ambrisentan (Letairis) — ERA, once-daily dosing; no routine liver monitoring needed
• Macitentan (Opsumit) — ERA with sustained tissue receptor binding; demonstrated morbidity/mortality benefit in SERAPHIN trial
• Treprostinil (Orenitram/Tyvaso/Remodulin) — prostacyclin analog available in oral, inhaled, and parenteral formulations

For CTEPH Patients

Adempas is the only FDA-approved medical therapy for CTEPH. If Adempas is inaccessible:

• Reassess surgical candidacy for pulmonary thromboendarterectomy (PTE)
• Consider balloon pulmonary angioplasty (BPA) for inoperable patients
• Off-label use of PAH-targeted therapies (ERAs, prostacyclin analogs) may be considered with appropriate documentation

For detailed alternative information, see alternatives to Adempas.

Workflow Tips for Your Practice

• Designate a specialty pharmacy coordinator — having one staff member responsible for all REMS and specialty pharmacy communications reduces errors and delays
• Create a REMS checklist — standardize the enrollment process with a checklist that includes pregnancy testing, contraception counseling, patient signatures, and prescriber certification verification
• Template your PA letters — pre-built prior authorization letters with fields for patient-specific clinical data save significant time
• Bookmark key resources — Medfinder for Providers, adempasrems.com, and the Aim program phone number should be accessible to all clinical staff
• Document access barriers — tracking how often patients experience delays, denials, or cost barriers helps identify systemic issues and supports advocacy efforts

Final Thoughts

Adempas is not in shortage, but its REMS-restricted distribution creates real access challenges for patients. As a provider, the most impactful thing you can do is front-load the specialty pharmacy process — initiate coordination, submit PA, enroll patients in financial assistance, and track refills proactively.

Use Medfinder for Providers to check real-time availability and share access tools with your patients. When access barriers are insurmountable, have a clear plan for alternative therapies.

For additional provider resources, see our guides on the Adempas shortage briefing, drug interactions, and helping patients save money on Adempas.