CIGNA HealthCare Prior Authorization Form - Revlimid (lenalidomide) 2010-2025 free printable template

CIGNA HealthCare Prior Authorization Form - Pharmacy Services Notice Failure to complete this form in its entirety may result in delayed processing or an adverse determination for insufficient information. Phone 800 244-6224 Fax 800 390-9745 PROVIDER INFORMATION PATIENT INFORMATION Provider Name Specialty Due to privacy regulations we will not be able to respond via fax with the outcome of our review unless all asterisked it...

How to fill out prior authorization revlimid lenalidomide form

How to fill out CIGNA HealthCare Prior Authorization Form - Revlimid

1. Obtain the CIGNA HealthCare Prior Authorization Form for Revlimid from the CIGNA website or your healthcare provider.
2. Fill in the patient's personal information, including name, date of birth, and insurance details.
3. Provide the prescribing physician's contact information and NPI number.
4. Indicate the specific diagnosis for which Revlimid is being prescribed.
5. List the medical history relevant to the request, including previous treatments and responses.
6. Include details about the requested medication, dosage, and duration of treatment.
7. Attach any necessary supporting documentation, such as lab results or previous treatment records.
8. Review the completed form for accuracy and completeness.
9. Submit the form via fax or online through CIGNA's authorization portal, following any specific submission guidelines.
10. Wait for confirmation of authorization or any follow-up requests for additional information.

Who needs CIGNA HealthCare Prior Authorization Form - Revlimid?

1. Patients diagnosed with conditions that require treatment with Revlimid, such as multiple myeloma or certain types of lymphoma.
2. Healthcare providers who are prescribing Revlimid and need to ensure coverage by CIGNA HealthCare.
3. Any patient seeking insurance coverage for Revlimid who needs to comply with CIGNA's prior authorization requirements.

People Also Ask about health authorization revlimid

What is the formulation of lenalidomide?

Lenalidomide | C13H13N3O3 - PubChem.

What is the difference between Revlimid and lenalidomide?

Lenalidomide is a cancer drug. It is also known by its brand name Revlimid. It is a treatment for: myeloma.

How much does Revlimid cost per month?

Celgene launched Revlimid in 2005 at a price of $215 per pill. After more than 20 price hikes, the drug now costs $763 per pill, or $16,023 per month.

Is Revlimid a chemotherapy drug?

Revlimid is not a chemotherapy drug it is an immune-modulating treatment that helps your immune system to fight cancer.

Is Revlimid a chemo treatment?

Revlimid, also known as lenalidomide, is an oral drug that is used for the treatment of multiple myeloma. It is part of a class of drugs called immunomodulatory drugs (IMiDs), which work against cancer cells partly by supporting the function of the immune system.

Is Revlimid a cancer drug?

Lenalidomide is a cancer drug. It is also known by its brand name Revlimid. It is a treatment for: myeloma.

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What is CIGNA HealthCare Prior Authorization Form - Revlimid?

The CIGNA HealthCare Prior Authorization Form - Revlimid is a document required to obtain approval from CIGNA for coverage of the medication Revlimid, which is used to treat specific medical conditions like multiple myeloma and certain types of lymphoma.

Who is required to file CIGNA HealthCare Prior Authorization Form - Revlimid?

Healthcare providers, such as physicians or prescribing specialists, are required to file the CIGNA HealthCare Prior Authorization Form - Revlimid on behalf of their patients who need to obtain prior authorization for the medication.

How to fill out CIGNA HealthCare Prior Authorization Form - Revlimid?

To fill out the CIGNA HealthCare Prior Authorization Form - Revlimid, the healthcare provider must complete sections that include patient information, treatment history, diagnosis, and medical justification for the use of Revlimid, along with any accompanying documentation.

What is the purpose of CIGNA HealthCare Prior Authorization Form - Revlimid?

The purpose of the CIGNA HealthCare Prior Authorization Form - Revlimid is to ensure that the prescribing of Revlimid meets the necessary medical criteria established by CIGNA, allowing for appropriate use and medical necessity review.

What information must be reported on CIGNA HealthCare Prior Authorization Form - Revlimid?

The information that must be reported on the CIGNA HealthCare Prior Authorization Form - Revlimid includes patient demographics, diagnosis codes, previous treatments, clinical evidence supporting the use of Revlimid, and physician details.