Get the free BCBSGa Remodulin PAB Fax Form

This form is used to request prior authorization for the medication Remodulin (treprostinil sodium) for patients diagnosed with pulmonary arterial hypertension.

How to fill out bcbsga remodulin pab fax

How to fill out BCBSGa Remodulin PAB Fax Form

1. Obtain the BCBSGa Remodulin PAB Fax Form from the appropriate source.
2. Fill out the patient's personal information, including name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including name, contact number, and NPI number.
4. Indicate the medical necessity for Remodulin treatment by attaching relevant medical records and history.
5. Fill in medication details including dosage, frequency, and administration route.
6. Sign and date the form to confirm the information is accurate.
7. Fax the completed form to the designated BCBSGa PAB fax number.

Who needs BCBSGa Remodulin PAB Fax Form?

1. Patients who have been prescribed Remodulin for pulmonary arterial hypertension.
2. Healthcare providers seeking prior authorization for Remodulin to ensure coverage through BCBSGa.
3. Pharmacists who need to confirm insurance coverage for filling Remodulin prescriptions.

People Also Ask about

How much does Remodulin cost per month?

Rounding out GoodRx's top 20 rankings is United Therapeutics' Remodulin, which treats pulmonary arterial hypertension. The drug costs $25,466 per month, but could face generics soon under patent agreements the company has inked with Sandoz, Teva, Par Pharmaceuticals and other generics companies.

How much does Remodulin cost?

Table 1Cost Comparison Table for Drugs Used for the Treatment of Pulmonary Arterial Hypertension Drug/ ComparatorStrengthAverage Daily Drug Cost ($) Treprostinil sodium (Remodulin) 1 mg/mL 2.5 mg/mL 5 mg/mL 10 mg/mL 142.81 to 281.25 Up to 473.68 Stimulators of sGC Riociguat (Adempas) 0.5 mg 1.0 mg 1.5 mg 2.0 mg 2.5 mg 128.2512 more rows

How to calculate Remodulin?

Calculating SC (undiluted) Remodulin Infusion rate1: *Conversion factor of 0.00006 = 60 min/hour x 0.000001 mg/ng.

What is the concentration of Remodulin vial?

Remodulin is supplied in 20-mL multidose vials in eight strengths, containing 2 mg (0.1 mg/mL), 4 mg (0.2 mg/mL), 8 mg (0.4 mg/mL), 20 mg (1 mg/mL), 50 mg (2.5 mg/mL), 100 mg (5 mg/mL), 200 mg (10 mg/mL), or 400 mg (20 mg/mL) of treprostinil.

Is Remodulin a high risk drug?

What are the serious side effects of Remodulin? Continuous intravenous (IV) infusions of Remodulin delivered using an external infusion pump, with a tube placed in a central vein within the chest, are associated with the risk of blood stream infections and sepsis, which may be fatal.

Is treprostinil the same as Remodulin?

Remodulin- Brand name of Generic Treprostinil.

What is the infusion rate for Remodulin?

Remodulin is administered by continuous infusion. Remodulin is preferably infused subcutaneously, but can be administered by a central intravenous line if the subcutaneous route is not tolerated, because of severe site pain or reaction. The infusion rate is initiated at 1.25 ng/kg/min.

How do you calculate Remodulin?

Calculating SC (undiluted) Remodulin Infusion rate1: *Conversion factor of 0.00006 = 60 min/hour x 0.000001 mg/ng.

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What is BCBSGa Remodulin PAB Fax Form?

The BCBSGa Remodulin PAB Fax Form is a document used to request prior authorization for the medication Remodulin, which is used in the treatment of pulmonary arterial hypertension.

Who is required to file BCBSGa Remodulin PAB Fax Form?

Healthcare providers prescribing Remodulin on behalf of patients typically need to file the BCBSGa Remodulin PAB Fax Form.

How to fill out BCBSGa Remodulin PAB Fax Form?

To fill out the BCBSGa Remodulin PAB Fax Form, providers must complete all required fields with accurate patient information, prescriber details, and medication specifics, and then submit the form via fax to the designated number.

What is the purpose of BCBSGa Remodulin PAB Fax Form?

The purpose of the BCBSGa Remodulin PAB Fax Form is to obtain prior authorization from BCBSGa for coverage of the Remodulin medication for patients who require it.

What information must be reported on BCBSGa Remodulin PAB Fax Form?

The information that must be reported includes patient demographics, prescribing physician details, medical history relevant to the treatment, current medications, and clinical rationale for the use of Remodulin.