Get the free stelara online pharmacy

A document used by pharmacies to collect patient information and coverage criteria for the medication Stelara, including diagnosis, dosages, and supporting documentation.

How to fill out stelara online pharmacy form

How to fill out Stelara Coverage Fax-back Sheet

1. Obtain the Stelara Coverage Fax-back Sheet from the healthcare provider or insurance company.
2. Fill out the patient's personal information, including name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including their name, contact number, and NPI number.
4. Indicate the diagnosis and the medical necessity for Stelara treatment.
5. Attach any relevant medical records or documentation that supports the request for Stelara.
6. Ensure all sections of the form are completed accurately.
7. Review the completed form for any errors or missing information.
8. Fax the completed sheet to the appropriate insurance provider or designated recipient.

Who needs Stelara Coverage Fax-back Sheet?

1. Patients who are prescribed Stelara for treatment.
2. Healthcare providers who need to request prior authorization from insurance companies.
3. Pharmacies handling insurance claims for Stelara prescriptions.

People Also Ask about

Does STELARA help with arthritis?

Ustekinumab is a drug that reduces the signs and symptoms of active psoriatic arthritis, such as psoriasis and joint swelling. It is also approved for the treatment of plaque psoriasis and moderate to severe, active Crohn's disease. Ustekinumab is commonly known as Stelara®. It is a type of drug called a biologic.

What is the fax number for STELARA with me?

Complete and fax this form to 866-769-3903. For assistance, prescribers can call 844-4-withMe (844-494-8463), Monday–Friday, 8:00 am–8:00 pm ET Please be sure to have your patient complete the Patient Authorization Form and submit it with this completed Enrollment and Prescription Form.

Does Stelara treat arthritis?

STELARA® is an FDA-approved therapy that treats and helps control the main symptoms of psoriatic arthritis.

Does Stelara help with inflammation?

Ustekinumab (Stelara) is a biologic medication used to lower inflammation and help adult patients and patients six years or older with moderate to severe plaque psoriasis, adult patients with psoriatic arthritis, and adult patients with moderate to severe Crohn's Disease and Ulcerative Colitis.

Is STELARA medical or pharmacy benefit?

If self-administered, it goes under the pharmacy (Rx) benefit. POLICY: Stelara (ustekinumab) is the preferred ustekinumab product for all lines of business under the medical benefit and for all Commercial (including Exchange and Essential Plan) and SafetyNet formularies on the pharmacy benefit.

What is the copay for STELARA?

Eligible patients using commercial or private insurance can save on out-of-pocket medication costs for STELARA®. Eligible patients pay $5 for each dose. Maximum program benefit per calendar year shall apply.

For pdfFiller’s FAQs

What is Stelara Coverage Fax-back Sheet?

The Stelara Coverage Fax-back Sheet is a document used by healthcare providers to facilitate the prior authorization process for Stelara, a medication used to treat certain autoimmune conditions. It is often required by insurance companies to determine coverage eligibility.

Who is required to file Stelara Coverage Fax-back Sheet?

Healthcare providers who are prescribing Stelara on behalf of their patients are typically required to file the Stelara Coverage Fax-back Sheet to ensure that the insurance company will cover the medication.

How to fill out Stelara Coverage Fax-back Sheet?

To fill out the Stelara Coverage Fax-back Sheet, providers need to complete sections that include patient information, prescribing physician details, medical history, and other relevant clinical information that supports the necessity of prescribing Stelara.

What is the purpose of Stelara Coverage Fax-back Sheet?

The purpose of the Stelara Coverage Fax-back Sheet is to provide the insurance company with the necessary information to evaluate and approve prior authorization requests for Stelara, ensuring patients have access to their prescribed medication.

What information must be reported on Stelara Coverage Fax-back Sheet?

Information that must be reported on the Stelara Coverage Fax-back Sheet typically includes patient demographics, diagnosis details, previous treatments, physician information, and any other data that supports the clinical need for Stelara.