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This document is a prior authorization form for Zavesca® (miglustate), intended for completion by physicians to initiate the approval process for medication benefits, particularly for patients with
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How to fill out zavesca pab fax form
How to fill out Zavesca PAB Fax Form
01
Begin by downloading the Zavesca PAB Fax Form from the official website or obtaining it from your healthcare provider.
02
Fill in the patient's personal information, including name, date of birth, and insurance details.
03
Include the prescribing physician's information such as name, contact number, and address.
04
Provide medical history relevant to Zavesca treatment, including previous medications and treatments.
05
Indicate the dosage and duration of therapy as prescribed by the physician.
06
Sign and date the form as required.
07
Attach any necessary supporting documents such as lab results or previous treatment records.
08
Send the completed form via fax to the designated number provided in the instructions.
Who needs Zavesca PAB Fax Form?
01
Patients diagnosed with Gaucher disease who are being prescribed Zavesca.
02
Healthcare providers facilitating treatment access for their patients.
03
Pharmacies or insurance companies requiring the form for authorization or reimbursement.
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People Also Ask about
How does miglustat work?
Miglustat is in a class of medications called enzyme inhibitors. It works by preventing the body from producing the fatty substance so that less of it will build up in the body and cause symptoms.
What is the indication of ranitidine?
BACKGROUND: Ranitidine is a histamine-2 blocker, which decreases the amount of acid created by the stomach. Prescription ranitidine is approved for multiple indications, including treatment and prevention of ulcers of the stomach and intestines and treatment of gastroesophageal reflux disease.
What category is miglustat?
Miglustat is in a class of medications called enzyme inhibitors.
Who makes miglustat?
Actelion Pharmaceuticals US, Inc.
What is the chemical name for miglustat?
Miglustat C10H21NO4 CID 51634 - PubChem.
What is the indication of ZAVESCA?
ZAVESCA is indicated as monotherapy for the treatment of adult patients with mild to moderate type 1 Gaucher disease for whom enzyme replacement therapy is not a therapeutic option (e.g. due to allergy, hypersensitivity, or poor venous access).
Is miglustat FDA approved?
It was approved for medical use in the European Union in November 2002, and for medical use in the United States in July 2003.
What is the brand name for Miglustat?
Miglustat, commonly marketed under the trade name Zavesca, is a drug used to treat Gaucher disease.
What is the drug Zavesca used for?
ZAVESCA® is a prescription medicine used alone to treat adults with mild to moderate type 1 Gaucher disease. ZAVESCA® is used only in people who cannot be treated with enzyme replacement therapy. It is not known if ZAVESCA® is safe and effective in children under 18 years of age.
What is ZAVESCA used for?
ZAVESCA® is a prescription medicine used alone to treat adults with mild to moderate type 1 Gaucher disease. ZAVESCA® is used only in people who cannot be treated with enzyme replacement therapy. It is not known if ZAVESCA® is safe and effective in children under 18 years of age.
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What is Zavesca PAB Fax Form?
The Zavesca PAB Fax Form is a document used to request prior authorization for the use of Zavesca, a medication indicated for specific conditions.
Who is required to file Zavesca PAB Fax Form?
Healthcare providers or prescribers of Zavesca are required to file the Zavesca PAB Fax Form to obtain necessary authorizations from insurance providers.
How to fill out Zavesca PAB Fax Form?
To fill out the Zavesca PAB Fax Form, the healthcare provider needs to complete the patient and prescriber information sections, provide relevant medical history, and indicate the reason for the request and any prior treatments.
What is the purpose of Zavesca PAB Fax Form?
The purpose of the Zavesca PAB Fax Form is to streamline the process of obtaining prior authorization for prescribed treatment with Zavesca, ensuring that patients have access to necessary medications.
What information must be reported on Zavesca PAB Fax Form?
The Zavesca PAB Fax Form must report patient demographics, insurance information, medical conditions, treatment history, and the specific dosage and duration of Zavesca requested.
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