How to access Opsynvi from India — the named-patient import pathway, 2026
By Reserve Meds · Clinical & regulatory team · Last reviewed 2026-04-24
An Indian adult with pulmonary arterial hypertension (PAH, WHO Group 1) may receive a prescription for Opsynvi (a fixed-dose combination of macitentan and tadalafil) from their treating pulmonologist or PAH specialist. Opsynvi is FDA-approved in the United States as a single once-daily oral tablet combining an endothelin-receptor antagonist (macitentan) with a PDE-5 inhibitor (tadalafil), intended to simplify dual-pathway PAH therapy for appropriate patients. Because Opsynvi is not yet routinely stocked in Indian hospital pharmacies, your specialist may be coordinating a named-patient import pathway on your behalf.
This guide explains the legal pathway, what documentation your physician needs, typical timing and cost bands, and where Reserve Meds fits in.
The clinical situation
Opsynvi is a once-daily oral fixed-dose combination providing macitentan 10 mg with tadalafil 40 mg. The manufacturer is Johnson & Johnson (Janssen/Actelion). Eligibility rests on confirmed WHO Group 1 PAH (typically supported by right heart catheterisation) where dual oral therapy with an ERA and a PDE-5 inhibitor is the clinical plan. The label provides a pathway for patients starting de novo on dual therapy and for patients consolidating from separate macitentan and tadalafil tablets onto a single pill. Your specialist confirms diagnosis, haemodynamics, risk stratification, drug interactions (including nitrates, which are contraindicated with tadalafil), and the monitoring plan — which includes liver function for the ERA component and standard PAH follow-up — per FDA labeling.
Is Opsynvi legally importable into India?
Yes — through the Central Drugs Standard Control Organization (CDSCO) personal-use / named-patient import framework. India has a mature pathway for importing medicines that are approved by recognised reference regulators but not yet locally marketed, used routinely for specialty cardiopulmonary products.
The CDSCO route typically rests on: (a) FDA or equivalent approval of the medicine, (b) the absence of a suitable locally registered alternative (in this case a single-pill dual-pathway PAH combination), (c) a prescription from a registered Indian medical practitioner who takes clinical responsibility, and (d) documented chain of custody from the US source to the treating facility.
How the pathway works, step by step
- Consultation with your treating PAH specialist. Confirmation of WHO Group 1 PAH, right heart catheterisation findings, dual-therapy indication, drug-interaction review, and a written clinical rationale.
- Treatment-centre identification. A tertiary pulmonology or cardiology service with PAH expertise and LFT monitoring capability accepts the case.
- CDSCO named-patient application. Your physician or the hospital's licensed importing pharmacy files the application including prescription, diagnostic documentation, and chain-of-custody plan.
- US-side sourcing. Reserve Meds coordinates with our US-licensed specialty wholesale partner to secure product from the manufacturer's authorised distribution chain under DSCSA.
- Stable shipment. Opsynvi is an oral tablet with standard storage requirements and ships with chain-of-custody documentation end to end.
- Arrival and initiation. Your specialist starts therapy at one tablet once daily and arranges follow-up LFTs and PAH status assessments. Reserve Meds coordinates re-supply ahead of bottle depletion.
What documentation your physician needs
Your physician will typically need to provide:
- A clinical rationale letter confirming WHO Group 1 PAH, right heart catheterisation findings, dual-therapy rationale, and Opsynvi as the indicated fixed-dose combination
- Verification of their Indian medical registration (state medical council registration number)
- A current prescription naming the product, once-daily dosing, and the planned schedule
- Patient identifier (anonymised reference preferred)
- Planned monitoring cadence (LFTs, haemoglobin, PAH status)
Reserve Meds provides a physician documentation kit bundling the templates CDSCO reviewers expect to see for oral PAH combination therapies under named-patient import.
Costs and timing
Opsynvi's US cash-pay reference price for a 30-day supply sits in an indicative 2026 range of roughly USD 13,000–16,000. Logistics, CDSCO documentation handling, and concierge coordination add incremental cost; Reserve Meds issues a full transparent quote at the start of intake, with a drug-only reference figure separated from service charges.
Indicative timing — not guaranteed — for first shipment arrival after cohort intake opens is approximately 7–14 days from the moment a complete CDSCO application is submitted. Subsequent re-supply cycles are generally faster once the pathway is established.
Reserve Meds is in pre-launch. Fulfillment availability is limited to our first cohort, and all timelines published on this site are indicative. If your clinical situation is time-sensitive, flag that when you join the waitlist — we triage accordingly.
A culturally-aware note: India has several high-volume PAH centres of excellence across Delhi, Mumbai, Chennai, Bengaluru, Hyderabad, and Kolkata. Our concierge team can coordinate with any of them, in English or the regional language your family prefers.
Reserve Meds's role
Reserve Meds is a US-based concierge coordinator for cross-border specialty medicine. For Opsynvi specifically, we provide:
- Sourcing. Through our US-licensed specialty wholesale partner, operating under DSCSA chain-of-custody.
- Documentation. Regulatory documentation package for your physician and for CDSCO review, including PAH-diagnostic attestation templates.
- Logistics. Shipment coordination and chain-of-custody.
- Concierge case lead. A named point of contact for your family and your physician throughout the process.
What we do not do: we are not the prescriber, we do not practise medicine, and we are not the dispensing pharmacy. All clinical decisions remain with your treating PAH specialist. We operate on a waitlist basis during our pre-launch phase.
Frequently asked
Is this legal in India? Yes, when executed through the CDSCO personal-use / named-patient framework with appropriate documentation. See our trust and compliance page.
Why a fixed-dose combination instead of separate pills? Single-pill combinations reduce pill burden and can improve adherence in chronic therapies like PAH. The choice between separate and combined tablets is a clinical decision based on your specialist's preference and your individual case.
Are there contraindications I should know about? Yes — concurrent nitrates (for angina) are contraindicated with tadalafil and therefore with Opsynvi. Your specialist reviews the full interaction list before prescribing.
Do I still need monitoring if the components are familiar? Yes. ERA-class agents carry liver-function monitoring requirements, and PAH follow-up continues on the standard cadence your specialist sets.
Will private insurance cover this? Cash-pay is the default. Some Indian private insurers and employer plans reimburse named-patient PAH imports on a case-by-case basis; we supply documentation for your submission but do not process insurance claims directly.
Next step — join the first-cohort waitlist
Reserve Meds is opening to a limited first cohort in 2026. Add your case to the waitlist and our concierge case lead will reach out when we are ready to enter intake for Opsynvi coordination in India.
Add me to the Opsynvi waitlistExamples and timings above are composite illustrations drawn from published sources and typical named-patient patterns. Your individual case is assessed by your physician and our clinical-regulatory team; Reserve Meds does not guarantee outcomes or timelines.
Clinical & regulatory review: Reserve Meds clinical team and AI regulatory-counsel review pipeline. Last medically reviewed: 2026-04-24.