Posted on September 2nd 2026
The PAH therapy treprostinil can now be considered as a treatment option across the whole of the UK, following a long campaign to update an NHS England commissioning policy.
The drug has been routinely prescribed in Scotland and Northern Ireland for over 20 years, but since 2014, patients in England and Wales have only been able to access it through individual funding requests. The updated policy means it can now be considered for all eligible pulmonary arterial hypertension (PAH) patients throughout the UK.
Treprostinil – often remembered by its old brand name Remodulin – is a prostacyclin drug that works by dilating the narrowed blood vessels in the lungs caused by PAH. It’s administered as a continuous infusion under the skin (subcutaneously) via a tiny pump connected to a fine needle.
Here at the PHA UK we have campaigned for this policy update for many years, and it was finally actioned on 28th July, following an intensification of our activity.
PHA UK Chair Dr Iain Armstrong said: “It has been a long and frustrating wait for the policy to be updated, but we never stopped applying pressure, and I’m delighted these efforts have paid off. Equity of access to treatments has always been important to our charity.
“The delay was bureaucratic rather than clinical; treprostinil is licensed, it’s tendered, and it has been used elsewhere for years. What held it up was process and red tape. Several years of waiting for a decision that nobody was clinically arguing against is not acceptable.”
Treprostinil isn’t suitable for everyone, and the policy update applies only to certain patients in WHO functional classes three or four. Specialist centres can now consider the drug as an option, but doctors will decide whether it’s right for each individual.
Professor Luke Howard, Consultant Pulmonologist at Hammersmith Hospital and Professor of Practice (Cardiopulmonary Medicine) at the National Heart and Lung Institute, Imperial College London, said: “I used treprostinil throughout the first decade of my career in PH, so I was very disappointed when it was withdrawn. For too long, access to this treatment depended on geography rather than clinical need, which was grossly unfair. That inequity has finally been put right.
“As treatment options for pulmonary hypertension continue to grow in 2026, having treprostinil back in our drug cabinets once again strengthens our ability to help patients live with PAH rather than suffer from it.”
Dr John Wort, Clinical Lead for Pulmonary Hypertension at Royal Brompton Hospital, added: “Sub-cutaneous treprostinil does provide an effective alternative treatment for some patients with pulmonary arterial hypertension who, for whatever reason, cannot manage intravenous prostacyclin. As always, our aim is to get the best individualised treatment for our patients, and the availability of treprostinil certainly helps with that goal. I would like to thank the PHA UK for their continuous campaigning to make this good news story possible.”
Treprostinil may not be available immediately as it will take time to organise supply and prescription processes. If you’re eligible for this treatment, your specialist centre will be in contact when the time is right.
Treprostinil is part of a class of drugs called prostacyclins, which are prescribed to PAH patients who need more advanced treatment. The most common of these types of drugs, and the one most people will have heard of, is epoprostenol – which can only be given intravenously through a Hickman line.
Another example is iloprost, which is nebulised into a mist and inhaled directly into the lungs. As it’s a short-acting drug, nebulised iloprost must be taken between six and nine times a day.
Like the other drugs in its class, treprostinil is a powerful ‘vasodilator’, working by opening blood vessels to allow more blood to flow through the narrowed vessels in the lungs.
The difference between treprostinil and other drugs is that it is designed to be given as a continuous infusion under the skin (instead of through a Hickman line). It’s administered automatically via a tiny pump, connected to a very fine needle via a small plastic cannula under the skin. The syringes need changing (by the patient) every two or three days.
