Get the free Zyflo Prior Authorization Form

This document is used to request prior authorization for the medication Zyflo (zileuton) for patients, requiring specific patient and prescriber information, documentation, and answers to eligibility

How to fill out zyflo prior authorization form

How to fill out Zyflo Prior Authorization Form

1. Obtain the Zyflo Prior Authorization Form from your healthcare provider or the insurance company's website.
2. Fill out the patient information section with the patient's full name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including their name, contact information, and NPI number.
4. Indicate the specific diagnosis and medical necessity for prescribing Zyflo.
5. List any previous treatments tried and the outcomes to justify the need for Zyflo.
6. Complete any additional sections required by the insurance provider, such as allergy information or preferred medications.
7. Review the completed form for accuracy and completeness.
8. Submit the form to the insurance provider via fax or online submission portal as instructed.
9. Follow up with the insurance provider to confirm receipt and check the status of the authorization.

Who needs Zyflo Prior Authorization Form?

1. Patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD) who require Zyflo as part of their treatment plan.
2. Healthcare providers prescribing Zyflo for patients who need insurance coverage for the medication.

People Also Ask about

Why was Zyflo taken off the market?

Chiesi USA Inc. is recalling 2118 bottles of Zyflo CR (zileuton) extended-release tablets, 600 mg, because samples failed to meet dissolution specifications, according to the June 19, 2019, US Food and Drug Administration (FDA) Enforcement Report.

What is the difference between Zyflo and Zyflo CR?

Zileuton was introduced in 1996 by Abbott Laboratories and is now marketed in two formulations by Cornerstone Therapeutics Inc. under the brand names Zyflo and Zyflo CR. The original immediate-release formulation, Zyflo, is taken four times per day. The extended-release formulation, Zyflo CR, is taken twice daily.

Is Zyflo still available?

Zileuton immediate-release tablets (Zyflo(R)) were withdrawn from the U. S. market by Critical Therapeutics on February 12, 2008.

Is zileuton better than montelukast?

Zileuton is better than montelukast as an additional drug in acute asthma and results in significant improvement in lung function, and reduction in the need for rescue medications.

Is Zyflo extended-release?

ZYFLO CR (zileuton) extended-release tablets for oral administration are triple-layer tablets comprised of an immediate-release layer, a middle (barrier) layer, and a extended-release layer.

What is a prior authorization form?

Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.

Is zileuton toxic to the liver?

Zileuton has been linked to rare cases of drug induced liver disease and is considered to be contraindicated in patients with active liver disease.

For pdfFiller’s FAQs

What is Zyflo Prior Authorization Form?

The Zyflo Prior Authorization Form is a document that healthcare providers must complete to obtain approval from insurance companies to prescribe Zyflo, a medication used to manage asthma and other respiratory issues.

Who is required to file Zyflo Prior Authorization Form?

Healthcare providers, such as doctors or prescribing physicians, are required to file the Zyflo Prior Authorization Form on behalf of their patients when seeking insurance approval for the medication.

How to fill out Zyflo Prior Authorization Form?

To fill out the Zyflo Prior Authorization Form, the healthcare provider must provide patient information, medical history, details about the prescribed medication, and the rationale for its necessity in the patient's treatment plan.

What is the purpose of Zyflo Prior Authorization Form?

The purpose of the Zyflo Prior Authorization Form is to ensure that the prescribed medication is medically necessary and to obtain necessary approval from the insurance provider for coverage.

What information must be reported on Zyflo Prior Authorization Form?

The Zyflo Prior Authorization Form must report patient identification details, insurance information, prescription information, diagnosis codes, previous treatments, and specific medical justifications for the use of Zyflo.