Medical therapy for PAH continues to evolve. In addition to the currently Food and Drug Administration-approved drugs (epoprostenol, treprostinil, iloprost, bosentan, and sildenafil), other related and unrelated drugs are being explored. Completely new directions include the use of imatinib, a drug that selectively suppresses the tyrosine kinase pathway conveying potent antiproliferative effects. This drug has proven effective in case reports of very ill PAH patients in whom aggressive therapy fails.13 Therapy for PAH is expensive, ranging from $10,000 to $35,000/yr for single-agent oral therapy, to well over $100,000/yr for parenteral therapy. Both cost and availability limit therapeutic options, particularly outside of the United States. Thus, BAS maintains a place in the therapeutic armamentarium for PAH; and in certain countries, it may be of critical importance, whether as a bridge to possible additional therapy, or the potential opportunity for a few more months of life. Still, we need better treatment and better access to it, particularly in patients with very advanced PAH. This disease is a worldwide problem, without worldwide access to therapy.