Treprostinil (Remodulin)

Covered: Remodulin (treprostinil) is covered for WHO Group 1 pulmonary arterial hypertension (including transition from epoprostenol) and for off‑label compendial use in CTEPH; uses not FDA‑approved or not compendial are excluded. Key requirements: initial PAH diagnosis must be confirmed by right‑heart catheterization with documented NYHA class III/IV (or class II only if currently receiving or having tried one oral agent or an inhaled/parenteral prostacyclin), prescribed by or in consultation with a pulmonologist or cardiologist, administered only as continuous subcutaneous or IV infusion (PAH up to 100 ng/kg/min; CTEPH up to 50 ng/kg/min), approved for 12 months with documentation of continued benefit for reauthorization (short‑term ≤30‑day supply allowed if criteria/info are lacking).

"For CTEPH: use when Remodulin is prescribed by or in consultation with a pulmonologist or a cardiologist (with re-authorization requiring continued benefit)."