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This document is used to request coverage for the Votrient medication, requiring patient and prescriber information, diagnosis details, and specific coverage criteria.
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How to fill out votrient coverage fax-back sheet
How to fill out Votrient® Coverage Fax-back Sheet
01
Gather the patient's information including name, date of birth, and contact details.
02
Fill in the prescribing physician's information including name, NPI number, and contact details.
03
Include the patient's insurance information such as policy number and insurance company.
04
Indicate the prescribed dosage and duration of Votrient® treatment.
05
Attach any relevant clinical notes or supporting documentation.
06
Review all provided information for accuracy and completeness.
07
Send the completed fax-back sheet to the designated insurance company fax number.
Who needs Votrient® Coverage Fax-back Sheet?
01
Patients who have been prescribed Votrient® and require insurance approval for coverage.
02
Healthcare providers, including oncologists or pharmacists, managing the patient's treatment and needing to obtain prior authorization.
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People Also Ask about
What is the half life of Votrient?
This estimate is based on the half-life of Votrient which is about 31 hours and experts agree that it takes up to 5 half-lives for a drug without active metabolites to be completely removed from the body. A drug's half-life is the time it takes for 50% of that drug to be removed from the body.
Does Votrient shrink tumors?
(Renal cell carcinoma is a type of kidney cancer. Soft tissue sarcoma is cancer of the soft tissue, such as muscles, tendons, nerves, and blood vessels.) Votrient may also help shrink these types of tumors. Talk with your doctor about what you can expect from Votrient treatment.
How long can you stay on Votrient?
Votrient is meant to be a long-term treatment. But how long you can take Votrient depends on how your body responds to it. It also depends on whether the drug is working well or causing harmful side effects.
Is there a generic for Votrient?
Pay as little as $0* for Teva's generic version of Votrient® (pazopanib) Tablets. *Commercially insured patients may pay as little as $0 out of pocket for Teva's Pazopanib Tablets.
What are the ingredients in Votrient?
Each film-coated tablet contains the equivalent of either 200 mg or 400 mg of pazopanib. Povidone (E1201) • Sodium starch glycollate • Magnesium stearate (E572) (vegetable source) • Hypromellose (E464) • Titanium dioxide (E171) • Macrogol (E1521) • Polysorbate 80 (E433) • Iron oxide red (E172) (200 mg tablets only).
What is the composition of Votrient?
QUALITATIVE AND QUANTITATIVE COMPOSITION Votrient 200 mg film-coated tablets Each film-coated tablet contains 200 mg pazopanib (as hydrochloride). Votrient 400 mg film-coated tablets Each film-coated tablet contains 400 mg pazopanib (as hydrochloride). For the full list of excipients, see section 6.1.
Is Votrient the same as pazopanib?
Pazopanib is a type of targeted cancer drug. It's pronounced pas-op-ann-ib. It is also known as Votrient.
What foods should you avoid while taking Votrient?
Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.
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What is Votrient® Coverage Fax-back Sheet?
The Votrient® Coverage Fax-back Sheet is a document used by healthcare providers to facilitate the prior authorization process for Votrient®, an oral medication used to treat certain types of cancer.
Who is required to file Votrient® Coverage Fax-back Sheet?
Healthcare providers or medical offices that are prescribing Votrient® for their patients are required to file the Votrient® Coverage Fax-back Sheet as part of the insurance authorization process.
How to fill out Votrient® Coverage Fax-back Sheet?
To fill out the Votrient® Coverage Fax-back Sheet, the healthcare provider must complete all required fields, including patient information, prescribing physician details, diagnosis, treatment plans, and insurance information before submitting it for prior authorization.
What is the purpose of Votrient® Coverage Fax-back Sheet?
The purpose of the Votrient® Coverage Fax-back Sheet is to ensure that insurance providers have the necessary information to approve the use of Votrient® for patients, thereby facilitating access to the medication.
What information must be reported on Votrient® Coverage Fax-back Sheet?
Information that must be reported on the Votrient® Coverage Fax-back Sheet includes patient demographics, prescription details, diagnosis codes, treatment history, and insurance information.
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