Epoprostenol (Flolan, Veletri)

Covered: Epoprostenol (Flolan, Veletri) is covered for FDA‑approved pulmonary arterial hypertension (WHO Group 1) to improve exercise capacity and for compendial off‑label use in chronic thromboembolic pulmonary hypertension (CTEPH); other indications are excluded. Key requirements: PAH must be confirmed by right‑heart catheterization with NYHA class III/IV (or class II only if currently receiving or having tried one oral agent or one inhaled/parenteral prostacyclin), idiopathic PAH must meet vasodilator/CCB testing or trial conditions, prescriber must be or consult a pulmonologist/cardiologist, dosing caps are 100 ng/kg/min for PAH and 45 ng/kg/min for CTEPH, approvals are for 12 months with reauthorization requiring documented ongoing clinical benefit, and a one‑time short supply (≤30 days) may be allowed if criteria are unmet but benefit is documented.

"For initial authorization: Has a diagnosis of pulmonary arterial hypertension (WHO Group I) confirmed by right heart catheterization."