Treprostinil (Remodulin)

Remodulin (treprostinil) is covered only for FDA‑approved pulmonary arterial hypertension (WHO Group I) and compendial off‑label chronic thromboembolic pulmonary hypertension (CTEPH) and is excluded for other indications or non‑WHO Group I pulmonary hypertension. Coverage requires WHO Group I confirmed by right‑heart catheterization, NYHA class III–IV (class II only if currently on or previously tried an oral PAH agent or an inhaled/parenteral prostacyclin), prescription/consultation by a pulmonologist or cardiologist, continuous subcutaneous (preferred) or intravenous infusion with dosing caps ≤100 ng/kg/min for PAH (≤50 ng/kg/min for CTEPH), 12‑month approvals with documented clinical benefit for reauthorization, and a one‑time 30‑day short supply if criteria or information are lacking.

"Treatment of pulmonary arterial hypertension (PAH) World Health Organization (WHO) Group I to diminish symptoms associated with exercise."