Treprostinil (Remodulin)

Remodulin (treprostinil) is covered only for WHO Group 1 pulmonary arterial hypertension and compendial off‑label use for CTEPH (other uses excluded) when specific criteria are met. Coverage requires right‑heart catheterization confirmation for PAH, prescription/consultation by a pulmonologist or cardiologist, NYHA class III/IV (or class II with prior/failed oral or inhaled/parenteral therapy) with additional vasodilator/CCB criteria for idiopathic PAH, continuous subcutaneous or IV infusion only (dosing limits: up to 100 ng/kg/min for PAH, 50 ng/kg/min for CTEPH), 12‑month approvals with documented continued benefit for reauthorization (short-term 30‑day supply allowed if criteria or documentation are incomplete).

"When requesting Remodulin (treprostinil) injection, the individual requiring treatment must be diagnosed with an FDA-approved indication or approved off-label compendial use and meet the specific c..."