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OPTIMA HEALTH PLAN PHARMACY PRIOR AUTHORIZATION/STEPPED REQUEST* Directions: The prescribing physician must sign and clearly print name (preprinted stamps not valid) on this request. All other information
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How to fill out drug name crizotinib?

01
Obtain the prescription: To fill out the drug name crizotinib, you must first have a valid prescription from a healthcare professional. Consult your doctor and obtain a written prescription for crizotinib.
02
Visit a pharmacy: Take the prescription to a pharmacy that carries crizotinib. Ensure that the pharmacy is licensed and reputable. Some medications may only be available at certain pharmacies, so it's important to find one that stocks crizotinib.
03
Provide necessary information: When you arrive at the pharmacy, present your prescription to the pharmacist. They will need your personal information, such as your full name, date of birth, and contact details. Be prepared to provide this information accurately to expedite the process.
04
Insurance information: If you have health insurance, provide your insurance card or information to the pharmacist. This will help determine the coverage and cost of crizotinib. If you do not have insurance, discuss potential alternative options with the pharmacist.
05
Prescription processing: The pharmacist will process your prescription by verifying the details, including the drug name, dosage, and quantity. They will also check for any potential drug interactions or allergies. This step ensures the safe and appropriate use of crizotinib based on your specific needs.
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Cost and payment: The pharmacist will inform you about the cost of crizotinib, taking into account your insurance coverage or any available discounts. If needed, discuss payment options with the pharmacist, such as using a health savings account or credit card.
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Medication counseling: Before dispensing crizotinib, the pharmacist may provide medication counseling to ensure you understand how to take it correctly. They will explain the dosage instructions, potential side effects, and any precautions you should be aware of.
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Receive the medication: Once the above steps are completed, you will receive your crizotinib prescription. The pharmacist will provide you with the correct dosage and quantity based on your prescription. Double-check the details before leaving the pharmacy to ensure accuracy.

Who needs drug name crizotinib?

01
Patients with non-small cell lung cancer: Crizotinib is primarily indicated for the treatment of advanced or metastatic non-small cell lung cancer (NSCLC) that carries specific genetic mutations. These mutations involve the ALK (anaplastic lymphoma kinase) gene rearrangements or ROS1 gene fusions. Individuals diagnosed with NSCLC and possessing these genetic alterations may benefit from crizotinib.
02
Healthcare professionals: Oncologists, pulmonologists, and other physicians involved in the management of NSCLC may prescribe crizotinib to eligible patients. These healthcare professionals make treatment decisions based on the patient's medical history, genetic testing results, and other relevant factors.
03
Individuals with appropriate genetic alterations: Crizotinib is designed to target specific gene mutations—ALK gene rearrangements and ROS1 gene fusions. Patients who have undergone genetic testing and been identified as having these specific mutations may be candidates for crizotinib treatment.
Remember, it is crucial to consult with a qualified healthcare professional who can assess your individual circumstances and determine if crizotinib is suitable for your condition.
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Crizotinib is a medication used to treat certain types of cancer, including non-small cell lung cancer.
Manufacturers, distributors, and marketers of crizotinib are required to file information about the drug.
To fill out information about crizotinib, companies must provide details on the drug's composition, dosage, side effects, and indications for use.
The purpose of crizotinib is to target specific genetic mutations in cancer cells to stop their growth and spread.
Information that must be reported includes clinical trial data, adverse event reports, and any changes to the drug's labeling or safety information.
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