Remodulin (treprostinil) — Medical Benefit Medication Utilization Policy
Defines medical benefit authorization criteria, quantity limits, and authorization period for Remodulin (treprostinil) when used to treat pulmonary arterial hypertension (PAH) for members covered by Community-Care.
No material clinical or coverage changes in this revision.
Coverage Criteria for Remodulin (treprostinil)
Initial and ongoing coverage for PAH
Covered when ALL of the following are met:
Covered when ALL of the following are met: Prescribed by, or in consultation with, a cardiologist or pulmonologist; diagnosis of pulmonary arterial hypertension (PAH) confirmed by right heart catheterization; and a weight is provided for approval. If these criteria are met, coverage is allowed for lifetime (subject to benefit changes).
There are no explicit exclusions listed in this policy and the document does not specify any conditions that are considered not medically necessary for Remodulin (treprostinil) use in PAH.
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