Get the free Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM

This form is used to request prior authorization for the medication Kuvan for patients diagnosed with Phenylketonuria (PKU), requiring adherence to a strict Phe-restrictive diet and treatment by a

How to fill out kuvan sapropterin dihydrochloride prior

How to fill out Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM

1. Begin by downloading the Kuvan® (sapropterin dihydrochloride) Prior Authorization Form from your healthcare provider's website or the manufacturer's website.
2. Fill in the patient’s personal information, including their full name, date of birth, and insurance details at the top of the form.
3. Provide the prescribing physician's information, including their name, address, and contact number.
4. Indicate the diagnosis for which Kuvan® is being prescribed, ensuring to include the relevant ICD-10 codes.
5. Document the patient's medical history, including previous treatments and responses.
6. List the prescribed dosage and frequency for Kuvan®, as well as the duration of treatment.
7. Include any supporting clinical documentation or lab results that may be required by the insurance company.
8. Review the form for accuracy and completeness to avoid any delays.
9. Sign and date the form before submitting it to the insurance company or healthcare provider as instructed.

Who needs Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

1. Patients diagnosed with phenylketonuria (PKU) who require treatment with Kuvan® (sapropterin dihydrochloride).
2. Healthcare providers who are prescribing Kuvan® and need to obtain prior authorization from the patient's insurance.
3. Insurance representatives who need to evaluate the medical necessity of the treatment before approving coverage.

People Also Ask about

What class of drug is sulfasalazine?

Sulfasalazine belongs to the drug class called disease-modifying anti-rheumatic drugs (DMARDs). It may also be called a 5-aminosalicylate or an antirheumatic.

What class of drug is sapropterin?

Sapropterin is a cofactor used as an adjunct to phenylalanine restriction in the treatment of phenylketonuria (PKU).

What class of drug is sapropterin dihydrochloride?

Sapropterin is in a class of medications called cofactors. It works by helping the body to break down phenylalanine so it will not build up in the blood.

What is the authorized generic for Kuvan?

Kuvan is the brand name of sapropterin dihydrochloride, and Javygtor is a trademarked name of sapropterin dihydrochloride, although it is still a generic product. Sapropterin dihydrochloride is supplied as brand and generic 100 mg tablets.

What is the response rate for Kuvan?

In two clinical trials at a Kuvan dose of 20 mg/kg per day, 56% to 75% of pediatric PKU patients showed a biochemical response to Kuvan, and in one clinical trial at a dose of 10 mg/kg per day, 20% of adult and pediatric PKU patients showed a biochemical response to Kuvan [see Clinical Studies (14)].

What class of drug is quinone?

The quinones are a class of organic compounds that are formally "derived from aromatic compounds [such as benzene or naphthalene] by conversion of an even number of –CH= groups into –C(=O)– groups with any necessary rearrangement of double bonds", resulting in "a fully conjugated cyclic dione structure".

What is the brand name for Sapropterin dihydrochloride?

KUVAN® (sapropterin dihydrochloride) Tablets for Oral Use and Powder for Oral Solution are prescription medicines used to lower blood Phe levels in adults and children over one month of age with a certain type of Phenylketonuria (PKU). KUVAN is to be used along with a Phe-restricted diet.

What class of drug is Faricimab SVOA?

Faricimab-svoa is in a class of medications called vascular endothelial growth factor-A (VEGF-A) and angiopoietin 2 (Ang-2) inhibitors. It works by stopping abnormal blood vessel growth and leakage in the eye(s) that may cause vision loss.

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What is Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

The Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM is a document that healthcare providers submit to insurance companies to obtain approval for coverage of the drug, which is used to treat phenylketonuria (PKU).

Who is required to file Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

Healthcare providers who prescribe Kuvan® for patients with PKU are required to file the PRIOR AUTHORIZATION FORM to ensure that the patient's insurance will cover the medication.

How to fill out Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

To fill out the form, a healthcare provider must provide patient information, medical history, the prescribed dosage of Kuvan®, and justification for the treatment, including clinical evidence of necessity for the patient's condition.

What is the purpose of Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

The purpose of the PRIOR AUTHORIZATION FORM is to facilitate the approval process for insurance coverage of Kuvan®, ensuring that patients have access to necessary treatments while allowing insurers to review treatment appropriateness.

What information must be reported on Kuvan® (sapropterin dihydrochloride) PRIOR AUTHORIZATION FORM?

The form must report the patient's personal details, diagnosis, previous treatments tried, specific medical information relevant to PKU, and the rationale for prescribing Kuvan® to demonstrate medical necessity.