Treprostinil is a molecule that was approved for the treatment of PAH in subcutaneous and IV forms initially., Its uniqueness was partially founded on its pharmacokinetics at room temperature, which offered stability and an extended half-life. Formulations of the molecule have expanded to include subcutaneous, IV, inhaled, and oral delivery routes. Understanding of each delivery method is growing, but the longest period of experience has been with the parenteral options. Although patients may have a higher comfort level with taking oral medications, there are reports of patients with progressive symptoms never receiving parenteral prostanoid therapy, which has a proven record of efficacy. Treprostinil is clearly a viable therapeutic option in patients who would benefit from advanced therapy. Side effects of treprostinil are variable, with some effects being more related to the molecule (headache, diarrhea, and jaw pain) and others being delivery method-specific. Challenges with treprostinil delivery have included central venous catheter infections with IV delivery. Alternatively, the subcutaneous infusion method, while not routinely associated with infections, has been associated with infusion site reactions (pain, erythema, and induration). The severity of patients’ side effects with subcutaneous treprostinil is variable, but in the extreme, can be a barrier to therapy. An additional large consideration to starting parenteral prostanoid therapy is the necessity of patients and family members to manage the complexities of the medication and infusion pumps. Although most patients excel in this situation, others would benefit from a more automated delivery method when IV or subcutaneous treatment options are unacceptable to the patient, when treatment fails as a result of side effects, or when therapy is unobtainable because of a patient limitation. In this issue of CHEST, Bourge et al introduce the PAH community to the option of an implantable, programmable intravascular delivery system for treprostinil infusion.