Pulmonary Hypertension Treatments and Selected Indications of Prostanoids

Aetna covers epoprostenol (Flolan, Veletri, generic), iloprost (Ventavis), treprostinil inhalation (Tyvaso) and injection (Remodulin/generic) for PAH when patients have WHO Group 1 PAH (Tyvaso also allowed for PH with interstitial lung disease) and PAH is confirmed by right‑heart catheterization (mPAP >20 mmHg, PCWP ≤15 mmHg, PVR ≥3 WU or PVRI ≥3 WU·m2 in pediatrics) or by Doppler echo for infants <1 year when cath is not possible; atrial septostomy and balloon pulmonary angioplasty are covered for refractory severe PAH or impaired systemic flow. All other indications are deemed experimental/investigational (including PH secondary to asthma/COPD/CHF/ischemic disease/lung resection), specific therapies like imatinib/simvastatin/sorafenib, prostanoids for ulcers/limb ischemia/CIDP, pulmonary artery denervation, implantable prostanoid pumps, and inhaled epoprostenol for aspiration pneumonitis/obesity hypoventilation are not supported, and implantable pump HCPCS E0782/E0783 and imatinib S0088 are excluded.