Veletri® (epoprostenol)

Authorization forms

Traditional, Optimized & Medicaid (03/2019)

No prior authorization required for Medicare

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J1325

Benefit: Medical

Notes: Treatment of primary pulmonary hypertension

Criteria for coverage:

  • See PA form for criteria for Commercial and Medicaid