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Thank you for your interest in prescribing Remodulin® (treprostinil) injection. This referral form has recently been revised to include the Remunity® Pump for Remodulin, a new subcutaneous delivery pump option for your patients.
United Therapeutics is committed to ensuring the best experience for you and your patients through education and support. To learn more about the pump and considerations prior to prescribing, please request additional information or a visit from a representative using the form below.
Thank you, your request has been received. Please click below to continue to the PDF download.
Prior Authorization Checklist
Request for Support Form
Sample Statement of Medical Necessity
Sample Appeal Letter
Sample Referral Form
Veterans Affairs Referral Form
Pharmacisit Information Form
Ordering Unituxin Form
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