Get the free BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form
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This document is a prior authorization form for the medication Sutent® (Sunitinib Malate) used by Blue Cross and Blue Shield of Vermont and The Vermont Health Plan.
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How to fill out bcbsvttvhp sutent sunitinib malate
How to fill out BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form
01
Obtain the BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form from the official website or provider.
02
Fill in the patient's personal information, including name, date of birth, and insurance details.
03
Provide clinical information, including diagnosis, relevant medical history, and treatment history.
04
Include details of the prescribed Sutent® dosage and administration schedule.
05
Attach supporting documents such as lab results, previous treatment information, and physician notes.
06
Sign and date the form, affirming that all information is accurate.
07
Submit the completed form to the appropriate BCBSVT/TVHP department via mail, fax, or online through their portal.
Who needs BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
01
Patients who have been prescribed Sutent® (Sunitinib Malate) for cancer treatment.
02
Healthcare providers who are treating patients with a diagnosis that requires prior authorization for Sutent®.
03
Pharmacies submitting claims for Sutent® on behalf of patients who require it.
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People Also Ask about
What is a SUTENT?
(SOO-tent) A drug used to treat adults with certain types of gastrointestinal stromal tumors, pancreatic neuroendocrine tumors, or renal cell carcinoma (a type of kidney cancer). It is also being studied in the treatment of other types of cancer.
Which of the following side effects would you most expect from sunitinib?
Common side effects include tiredness, diarrhea, and mouth sores. Call your health care provider right away if you get a rash, itching, fever, trouble breathing, chest pain, nausea, severe stomach pain, severe or persistent headache, or feel your heartbeat.
What are the serious side effects of sunitinib?
Sutent may cause heart problems that can lead to death. Heart problems may include heart failure, heart attack, and heart muscle problems (cardiomyopathy) that can lead to death. Tell your healthcare provider if you feel very tired, are short of breath, or have swollen feet and ankles.
How many years can you take sunitinib?
Patient summary. More than 800 mRCC patients received sunitinib for between 2 and 6 yr without experiencing new or more severe treatment-related toxicity. Clinicians may be able to prescribe chronic sunitinib treatment for as long as patients continue to derive clinical benefit, without untoward additional risk.
What is the drug sunitinib malate used for?
Sunitinib is used to treat a gastrointestinal stromal tumor (GIST) after other medicines (eg, ) did not work very well. It may also be used when patients are not able to take . GIST is a group of cancer cells that start growing in the wall of the stomach, , or rectum.
What is sunitinib malate?
Sunitinib (pronounced sue-nit-i-nib) is a targeted cancer drug. It is a treatment for: kidney cancer that has spread to other parts of the body (advanced or metastatic) a rare type of sarcoma called gastrointestinal stromal tumour. (GIST)
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What is BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
The BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form is a prior authorization form used by Blue Cross Blue Shield of Vermont (BCBSVT) and The Vermont Health Plan (TVHP) to determine the medical necessity of the medication Sutent® for patients.
Who is required to file BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
Healthcare providers prescribing Sutent® (Sunitinib Malate) on behalf of their patients are required to file the BCBSVT/TVHP PA Form to obtain approval for coverage from BCBSVT or TVHP.
How to fill out BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
To fill out the BCBSVT/TVHP Sutent® PA Form, the healthcare provider must provide patient information, relevant clinical details, diagnosis, treatment history, and justification for the use of Sutent®. The form should be completed accurately and submitted according to the guidelines provided.
What is the purpose of BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
The purpose of the BCBSVT/TVHP Sutent® PA Form is to evaluate whether the prescribed medication is medically necessary for the patient's condition, ensuring appropriate use of resources and adherence to insurance coverage policies.
What information must be reported on BCBSVT/TVHP Sutent® (Sunitinib Malate) PA Form?
The information that must be reported on the BCBSVT/TVHP Sutent® PA Form includes patient demographics, provider details, clinical diagnoses, treatment history, accompanying medical records, and any other information that supports the need for Sutent® as part of the patient's treatment plan.
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